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NPI Code Detail

MEDICARE: MS. BETTY VIRELLA LCSW

MEDICARE:  MS. BETTY  VIRELLA  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 Worker44SL05831600NJ
21041C0700XClinical Social Worker15750FL

General Provider Information

NPI Number : 1720416811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BETTY VIRELLA LCSW
Provider Business Mailing Address
First Line : 24711 PORTOFINO DR
Second Line :
City : LUTZ
State : FL
Zip : 33559-7405
Country : US
Telephone Number : 908-220-9132
Fax Number :
Provider Business Practice Location Address
First Line : 7821 N DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33614-3275
Country : US
Telephone Number : 813-443-4827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2013
Last Update Date : 09/22/2020

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Directions to “ MS. BETTY VIRELLA LCSW” Practice Location

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