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NPI Code Detail

MEDICARE: TAMARA S PETRELLI LCSW

MEDICARE:   TAMARA S PETRELLI  LCSW
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
1104100000XSocial WorkerISW 2130FL
21041C0700XClinical Social WorkerFL

General Provider Information

NPI Number : 1629290234
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA S PETRELLI LCSW
Provider Business Mailing Address
First Line : 7830 PINE TREE LN
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33406-7836
Country : US
Telephone Number : 561-662-6900
Fax Number :
Provider Business Practice Location Address
First Line : 1645 PALM BEACH LAKES BLVD STE 1200
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33401-2214
Country : US
Telephone Number : 561-662-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 10/30/2016

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Directions to “ TAMARA S PETRELLI LCSW” Practice Location

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