Provider Demographics
NPI:1154084226
Name:VELLO, NORENE M (LPCC)
Entity Type:Individual
Prefix:
First Name:NORENE
Middle Name:M
Last Name:VELLO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1900
Mailing Address - Country:US
Mailing Address - Phone:312-810-3319
Mailing Address - Fax:
Practice Address - Street 1:92 4TH AVE
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1900
Practice Address - Country:US
Practice Address - Phone:312-810-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDE0007826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty