MR. DAVID L MORTELLARO (NPI# 1851375836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851375836 |
| Entity Type | Individual |
| Full Name | MR. DAVID L MORTELLARO |
| Credential | LPC, LMFT |
| Practice Address |
4656 Brambleton Ave Roanoke VA 24018-3437 |
| Mailing Address |
6980 Highfields Farm Cir Roanoke VA 24018-5631 |
| Practice Telephone | 5407728043 |
| Practice Fax Number | 5407728242 |
| Mailing Telephone | 5407744114 |
| Mailing Fax Number | 5407728242 |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2008-10-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
0701001496 | VA | Behavioral Health & Social Service Providers |
| N | 106H00000X | Marriage & Family Therapist | 0717000603 | VA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | MAMSI | 349980 | 01 |
| VA | VA0101 | JOHN DEERE | 01 |
| VA | VALUE OPTIONS | 018061 | 01 |
| VA | VIRGINIA PREMIER (HMO) | 005400431 | 01 |
| VA | MAGELLAN | 297608000 | 01 |
| VA | AETNA | 5675123 | 01 |
| VA | CIGNA BEHAVIORAL HEALTH | 69554 | 01 |
| VA | SOUTHERN HEALTH/SENTARA | 087620 | 01 |
| VA | ANTHEM BCBS | 285978 | 01 |
| VA | 005400431 | 05 | |
| VA | MANAGED HEALTH NETWORK | 132303 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306129804 | David J Mortellaro | Counselor | 140 South Holly Street, Medford, OR 97501 | 2011-09-21 |
| Street Address |
4656 BRAMBLETON AVE |
| City | ROANOKE |
| State | VA |
| Zip Code | 24018-3437 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871585380 | Robert Paul Jessup | Counselor | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2005-08-19 |
| 1699947606 | Ruth S. Fielder | Social Worker | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2008-03-31 |
| 1679745616 | Deborah M Seagraves | Counselor | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2008-03-31 |
| 1114009453 | David Wiggins | Counselor | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2006-10-19 |
| 1548342876 | Hal Douglas Herold | Counselor | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2006-10-19 |
| 1013929033 | Amy W Elliott | Counselor | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2006-08-12 |
| 1417916065 | Ruth S Fielder | Social Worker | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2006-03-22 |
| 1669447660 | Laurel E Martin | Counselor | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2006-02-22 |
| 1568446144 | Timothy M Wilder | Counselor | 4656 Brambleton Ave, Roanoke, VA 24018-3437 | 2005-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770140253 | Luz Dione Carr | Nurse Practitioner | 1934 Maple Leaf Drive, Roanoke, VA 24018 | 2019-05-21 |
| 1467926527 | Embrace Foster Care, LLC | Foster Care Agency | 3912 Electric Road, Building C, Roanoke, VA 24018 | 2019-01-11 |
| 1174005417 | Roanoke Valley Ent & Allergy PC | Otolaryngology | 2154 Mcvitty Rd, Second Floor, Roanoke, VA 24018 | 2018-09-04 |
| 1265928535 | Jane Willis Warner | Behavior Technician | 3243 Electric Road Building E Suite 1b, Roanoke, VA 24018 | 2018-07-10 |
| 1821584640 | Anchor To Hope Counseling LLC | Counselor | 4370 Starkey Rd Ste 4c-1, Roanoke, VA 24018 | 2018-07-04 |
| 1164938619 | Aurora Domangue | Behavior Technician | 3243 Electric Road, Building E Suite 1b, Roanoke, VA 24018 | 2017-12-20 |
| 1376059089 | Maggie Marie Ridgeway | Behavior Technician | 3243 Electric Rd., Building E Suite 1b, Roanoke, VA 24018 | 2017-12-18 |
| 1700301850 | Nicole Graboski | Speech-Language Pathologist | 4920 Woodmar Drive Sw, Roanoke, VA 24018 | 2017-08-10 |
| 1891215893 | Kimberly Anne Rosenberger | Occupational Therapy Assistant | 2772 Hillbrook Dr., Roanoke, VA 24018 | 2017-06-21 |
| 1083158950 | Encompass Home Health of Roanoke, LLC | Home Health | 5115 Bernard Drive, Suite 205, Roanoke, VA 24018 | 2016-12-13 |
| Find all providers in zip 24018 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497352645 | Victor M Rivera Sink | Counselor | 637 Webster Heights Rd, Roanoke, VA 24012-8988 | 2020-10-01 |
| 1902427495 | Lance Crawford | Counselor | 17 Church Ave Sw Apt 303, Roanoke, VA 24011-2011 | 2020-05-06 |
| 1992325344 | Joy-filled Counseling, Pllc | Counselor | 15600 Yarberry Dr, Roanoke, TX 76262-3364 | 2020-04-24 |
| 1881226173 | Shelby M Wynn | Counselor | 1942 Fairhope Rd Nw, Roanoke, VA 24017-1708 | 2020-02-05 |
| 1215587423 | Tara Hutcheson | Counselor | 846 Campbell Ave Sw, Roanoke, VA 24016-3536 | 2019-09-19 |
| 1437702461 | John Aubrey Hosey | Counselor | 3023 Peters Creek Rd Nw Ste B, Roanoke, VA 24019-2758 | 2019-07-18 |
| 1740846773 | Heather Erin Hamed-moore | Counselor | 541 Luck Ave Sw Ste 209, Roanoke, VA 24016-5055 | 2019-05-15 |
| 1770046120 | Heartspace Counseling, Plc | Counselor | 2502 Broadway Ave Sw Uppr Unit, Roanoke, VA 24014-1663 | 2019-04-12 |
| 1821584640 | Anchor To Hope Counseling LLC | Counselor | 4370 Starkey Rd Ste 4c-1, Roanoke, VA 24018 | 2018-07-04 |
| 1053848507 | Natalie Sanders | Counselor | 4537 Hammond Ln, Roanoke, VA 24018-3921 | 2017-05-15 |
| Find all providers in ROANOKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.