Healthcare Provider Details

I. General information

NPI: 1093580656
Provider Name (Legal Business Name): VARSHA DEVI ELLANA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11874 DUMAINE VALLEY RD
RIVERVIEW FL
33579-7221
US

IV. Provider business mailing address

11874 DUMAINE VALLEY RD
RIVERVIEW FL
33579-7221
US

V. Phone/Fax

Practice location:
  • Phone: 727-488-0396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22241
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: