Healthcare Provider Details

I. General information

NPI: 1780809558
Provider Name (Legal Business Name): VITA MARIE CALLARI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 JULY LN
SAINT AUGUSTINE FL
32080-8631
US

IV. Provider business mailing address

9260 JULY LN
SAINT AUGUSTINE FL
32080-8631
US

V. Phone/Fax

Practice location:
  • Phone: 707-492-7133
  • Fax:
Mailing address:
  • Phone: 77-492-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17169
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11110
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: