Provider Demographics
NPI:1043771686
Name:BELLA SUDORE, PLLC
Entity Type:Organization
Organization Name:BELLA SUDORE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WARNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-284-4221
Mailing Address - Street 1:6383 W CONESTOGA ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-2069
Mailing Address - Country:US
Mailing Address - Phone:813-284-4221
Mailing Address - Fax:
Practice Address - Street 1:427 NE 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4248
Practice Address - Country:US
Practice Address - Phone:813-727-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty