Provider Demographics
NPI:1477847036
Name:CIRILLO, ANNALEA NICOLE
Entity Type:Individual
Prefix:
First Name:ANNALEA
Middle Name:NICOLE
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNALEA
Other - Middle Name:NICOLE
Other - Last Name:THELANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4320 SOUTH HIGUERA #1
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-602-2441
Mailing Address - Fax:805-262-6506
Practice Address - Street 1:4320 SOUTH HIGUERA #1
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-602-2441
Practice Address - Fax:805-262-6506
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health