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General NPI Number Information
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NPI Number | 1144618620
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Entity Type | Organization
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Legal Business Name | COLETTE J. IACOBELLIS, M.A., LLC
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 338 N PARK AVE SUITE 18
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City | WINTER PARK
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State | FL
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Zip | 32789-3815
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Country | US
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Telephone | 407-951-3820
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Fax |
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Provider Business Mailing Address
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Address Line | 338 N PARK AVE SUITE 18
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City | WINTER PARK
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State | FL
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Zip | 32789-3815
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Country | US
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Telephone | 407-951-3820
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Fax |
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Authorized Official
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Title or Position | CONTRACT COUNSELOR
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Name | COLETTE J. IACOBELLIS
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Credential | M.A.
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Telephone | 407-951-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | IMH11329
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License Number State | FL
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