Provider Demographics
NPI:1144618620
Name:COLETTE J. IACOBELLIS, M.A., LLC
Entity Type:Organization
Organization Name:COLETTE J. IACOBELLIS, M.A., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:IACOBELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:407-951-3820
Mailing Address - Street 1:338 N PARK AVE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3815
Mailing Address - Country:US
Mailing Address - Phone:407-951-3820
Mailing Address - Fax:
Practice Address - Street 1:338 N PARK AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3815
Practice Address - Country:US
Practice Address - Phone:407-951-3820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH11329251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health