Provider Demographics
NPI:1790171676
Name:ANSA, NORALI
Entity Type:Individual
Prefix:
First Name:NORALI
Middle Name:
Last Name:ANSA
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 1:110 CYPRESS WOODS CT APT 1B
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-9301
Mailing Address - Country:US
Mailing Address - Phone:386-569-0864
Mailing Address - Fax:
Practice Address - Street 1:215 S WOODLAND BLVD STE 201
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5401
Practice Address - Country:US
Practice Address - Phone:386-795-5695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-09023106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician