Individual provider Active NPI

Orietta Bornacelly

  • Mental Health Counselor
  • Hialeah, FL
National Provider Identifier
1265064273
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MT4771 Issued in FL
Practice address
3908 W 12TH Ave
Hialeah, FL 33012-4105
Phone
(786) 479-3936
NPI assigned
Feb 7, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X MT4771 FL Primary

Addresses

Primary practice location

3908 W 12TH Ave
Hialeah, FL 33012-4105

Mailing address

5125 SW 165TH Ave
Miami, FL 33185-5163
Phone (786) 479-3936

Other practice location 1

1165 Northwest 125 Place
Miami, FL 33182
Phone (786) 479-3936

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240415000894 FL Practitioner - Marriage and Family Therapist 1951740646 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MT4771FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Universal Community Services Inc. Single Specialty CurrentSince Sep 14, 2024 Accepting new patients
Grow Healthcare Group PA Mental Health CurrentSince Oct 22, 2024 Accepting new patients

Locations

3908 W 12th Ave
Hialeah, FL 33012
Phone (305) 400-8904

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1265064273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5125 SW 165TH AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331855163",
            "telephone_number": "786-479-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3908 W 12TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330124105",
            "telephone_number": "786-479-3936"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1165 Northwest 125 Place",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "33182",
            "country_code": "US",
            "telephone_number": "786-479-3936",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORNACELLY",
        "first_name": "ORIETTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-07",
        "last_updated": "2024-05-30",
        "certification_date": "2024-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MT4771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.