Provider Demographics
NPI:1669143103
Name:PANDISCIO, ALLIE MARYJANE
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:MARYJANE
Last Name:PANDISCIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 W HILLSBORO BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2114
Mailing Address - Country:US
Mailing Address - Phone:978-828-7783
Mailing Address - Fax:
Practice Address - Street 1:13650 NW EIGHTH ST
Practice Address - Street 2:UNIT 109
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33325
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-24-78448103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician