Provider Demographics
NPI:1376878116
Name:RUBINO-TILTTI, MARCELLA LISA (MA)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:LISA
Last Name:RUBINO-TILTTI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 LANDAU ST
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-5812
Mailing Address - Country:US
Mailing Address - Phone:727-512-3593
Mailing Address - Fax:
Practice Address - Street 1:12800 INDIAN ROCKS RD
Practice Address - Street 2:6C
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-2000
Practice Address - Country:US
Practice Address - Phone:727-512-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1339106H00000X
FLMH11191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist