Individual
GEORGINA MARIE PETRONELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1221 W BEN WHITE BLVD STE 210A, AUSTIN, TX 78704-7182
(512) 960-4533
Mailing address
1221 W BEN WHITE BLVD STE 210A, AUSTIN, TX 78704-7182
(512) 960-4533
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
68473
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68473
STATE LICENSE
TX
Enumeration date
05/18/2020
Last updated
05/18/2020
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