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General NPI Number Information
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NPI Number | 1376878116
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Entity Type | Individual
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Provider Name | MARCELLA LISA RUBINO-TILTTI M.A.
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Gender | Female
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 12800 INDIAN ROCKS RD 6C
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City | LARGO
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State | FL
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Zip | 33774-2000
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Country | US
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Telephone | 727-512-3593
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Fax |
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Provider Business Mailing Address
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Address Line | 1439 LANDAU ST
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City | HOLIDAY
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State | FL
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Zip | 34690-5812
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Country | US
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Telephone | 727-512-3593
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMT1339
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH11191
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License Number State | FL
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