Healthcare Provider Details

I. General information

NPI: 1306983168
Provider Name (Legal Business Name): VICKI L VANELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 METROWEST BLVD STE 103
ORLANDO FL
32835-3290
US

IV. Provider business mailing address

6150 METROWEST BLVD STE 103
ORLANDO FL
32835-3290
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-5600
  • Fax:
Mailing address:
  • Phone: 407-730-3837
  • Fax: 407-730-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: