Provider Demographics
NPI:1295382620
Name:DALLERA, ANNETTE (INTERN MFT)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:DALLERA
Suffix:
Gender:F
Credentials:INTERN MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16820 NW 21ST ST APT 6-103
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1860
Mailing Address - Country:US
Mailing Address - Phone:305-206-8048
Mailing Address - Fax:
Practice Address - Street 1:8245 NW 36TH ST STE 7
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6636
Practice Address - Country:US
Practice Address - Phone:305-594-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty