Provider Demographics
NPI:1073973665
Name:JALLORINA, CHRISTA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:JALLORINA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11309 EMERALD SHORE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4201
Mailing Address - Country:US
Mailing Address - Phone:571-719-7718
Mailing Address - Fax:
Practice Address - Street 1:11309 EMERALD SHORE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4201
Practice Address - Country:US
Practice Address - Phone:571-719-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123431041C0700X
VA09040093571041C0700X
FLSW163411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical