Provider Demographics
NPI:1790285096
Name:DINIZ, ALESSIANA
Entity Type:Individual
Prefix:
First Name:ALESSIANA
Middle Name:
Last Name:DINIZ
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 1:9885 COBBLESTONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4453
Mailing Address - Country:US
Mailing Address - Phone:561-305-0214
Mailing Address - Fax:
Practice Address - Street 1:9885 COBBLESTONE CREEK DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-4453
Practice Address - Country:US
Practice Address - Phone:561-305-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty