Basic Information
| Provider Information | |||||||||
| NPI: | 1396086757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORRELLI | ||||||||
| FirstName: | DIANNE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 SW ARCHER RD. | ||||||||
| Address2: | NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
| FaxNumber: | 3522714708 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 SW ARCHER RD. | ||||||||
| Address2: | MALCOM RANDALL HEALTHCARE SYSTEM | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
| FaxNumber: | 3522714708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2013 | ||||||||
| LastUpdateDate: | 03/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW10537 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.