Provider Demographics
NPI:1609457704
Name:FRALLICCIARDI, KAYA S
Entity Type:Individual
Prefix:
First Name:KAYA
Middle Name:S
Last Name:FRALLICCIARDI
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 1:2006 NW 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7757
Mailing Address - Country:US
Mailing Address - Phone:954-242-5564
Mailing Address - Fax:
Practice Address - Street 1:2006 NW 48TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-7757
Practice Address - Country:US
Practice Address - Phone:954-242-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst