MEDICARE: ORIETTA BORNACELLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MT4771	FL

General Provider Information

NPI Number	:	1265064273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORIETTA BORNACELLY

Provider Business Mailing Address
First Line	:	5125 SW 165TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5163
Country	:	US
Telephone Number	:	786-479-3936
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4105
Country	:	US
Telephone Number	:	786-479-3936
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	05/30/2024

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Directions to “ ORIETTA BORNACELLY ” Practice Location

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