Provider Demographics
NPI:1346763539
Name:SOLLACCIO, ANNABELLA SEABRA
Entity Type:Individual
Prefix:
First Name:ANNABELLA
Middle Name:SEABRA
Last Name:SOLLACCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FIELDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-3114
Mailing Address - Country:US
Mailing Address - Phone:973-296-1876
Mailing Address - Fax:
Practice Address - Street 1:59 E MILL RD UNIT 201
Practice Address - Street 2:
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-6222
Practice Address - Country:US
Practice Address - Phone:973-296-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00575400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional