Provider Demographics
NPI:1417711599
Name:FILETTE, DANIELA (BACB1010638)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:FILETTE
Suffix:
Gender:F
Credentials:BACB1010638
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 HOLLYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-1679
Mailing Address - Country:US
Mailing Address - Phone:786-399-5416
Mailing Address - Fax:
Practice Address - Street 1:11503 CANOPY LOOP
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9457
Practice Address - Country:US
Practice Address - Phone:059-173-1693
Practice Address - Fax:888-441-6806
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1010638106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician