=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124749916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YELITZA NUNEZ MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2022
-----------------------------------------------------
Last Update Date | 09/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 WEBB DR STE C
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33837-3921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-438-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 148 JULIE LN
-----------------------------------------------------
City | AUBURNDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33823-2335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-284-4993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------