Basic Information
| Provider Information | |||||||||
| NPI: | 1902149941 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORSELLI | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MS, CH.T, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 MONMOUTH LN | ||||||||
| Address2: | |||||||||
| City: | KEY LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330372811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059061268 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3000 41ST STREET OCEAN | ||||||||
| Address2: | |||||||||
| City: | MARATHON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330502373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054347660 | ||||||||
| FaxNumber: | 3054349040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 01/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH 13037 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.