Provider Demographics
NPI:1396086757
Name:BORRELLI, DIANNE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:MARIE
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 SW ARCHER RD.
Mailing Address - Street 2:NORTH FLORIDA/SOUTH GEORGIA VETERANS HEALTH SYSTEM
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:352-376-1611
Mailing Address - Fax:352-271-4708
Practice Address - Street 1:1601 SW ARCHER RD.
Practice Address - Street 2:MALCOM RANDALL HEALTHCARE SYSTEM
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:352-271-4708
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW105371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical