Provider Demographics
NPI:1790259646
Name:MEMOREABLE
Entity Type:Organization
Organization Name:MEMOREABLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMHC
Authorized Official - Phone:813-770-3118
Mailing Address - Street 1:3201 TAMIAMI TRL N STE 128
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4135
Mailing Address - Country:US
Mailing Address - Phone:800-961-3367
Mailing Address - Fax:800-961-3367
Practice Address - Street 1:3201 TAMIAMI TRL N STE 128
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4135
Practice Address - Country:US
Practice Address - Phone:800-961-3367
Practice Address - Fax:800-961-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV340-00066-869-0OtherDL