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General NPI Number Information
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NPI Number | 1265064273
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Entity Type | Individual
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Provider Name | ORIETTA BORNACELLY
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Gender | Female
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 3908 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4105
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Country | US
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Telephone | 786-479-3936
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Fax |
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Provider Business Mailing Address
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Address Line | 5125 SW 165TH AVE
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City | MIAMI
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State | FL
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Zip | 33185-5163
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Country | US
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Telephone | 786-479-3936
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MT4771
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License Number State | FL
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