Mortellaro, David L
Mortellaro, David L is an individual health care provider with primary practice located at 4656 Brambleton Ave , Roanoke VA 24018-3437. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Mortellaro, David L can be contacted via phone (540) 772-8043.Contact Information
Primary practice address
4656 Brambleton Ave
Roanoke VA 24018-3437
Phone: (540) 772-8043
Fax: (540) 772-8242
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 0701001496 | Virginia |
| Behavioral Health & Social Service Providers / Marriage & Family Therapist | 106H00000X | 0717000603 | Virginia |
Profile Details
| NPI number | 1851375836 |
|---|---|
| LBN Legal business name | Mortellaro, David L |
| Credentials | LPC, LMFT |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 2nd, 2005 |
| Last updated | Oct 2nd, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1851375836 | NPPES |
| Virginia | Other | 005400431 | VIRGINIA PREMIER (HMO) |
| Virginia | MEDICAID | 005400431 | VIRGINIA PREMIER (HMO) |
| Virginia | Other | 297608000 | VIRGINIA PREMIER (HMO) |
| Virginia | Other | 087620 | VIRGINIA PREMIER (HMO) |
| Virginia | Other | JOHN DEERE | VIRGINIA PREMIER (HMO) |
| Virginia | Other | 018061 | VIRGINIA PREMIER (HMO) |
| Virginia | Other | 132303 | VIRGINIA PREMIER (HMO) |
| Virginia | Other | 349980 | VIRGINIA PREMIER (HMO) |
| Virginia | Other | 285978 | VIRGINIA PREMIER (HMO) |
| Virginia | Other | 5675123 | VIRGINIA PREMIER (HMO) |
| Virginia | Other | 69554 | VIRGINIA PREMIER (HMO) |
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