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General NPI Number Information
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NPI Number | 1043771686
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Entity Type | Organization
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Legal Business Name | BELLA SUDORE, PLLC
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 427 NE 3RD ST STE C
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4248
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Country | US
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Telephone | 813-727-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 6383 W CONESTOGA ST
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-2069
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Country | US
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Telephone | 813-284-4221
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBIN MICHELLE WARNBERG
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Credential | LCSW
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Telephone | 813-284-4221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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