Provider Demographics
NPI:1740334424
Name:DALOTTO, RICHARD (FP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DALOTTO
Suffix:
Gender:M
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 E BETHANY HOME RD
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2198
Mailing Address - Country:US
Mailing Address - Phone:602-795-7232
Mailing Address - Fax:
Practice Address - Street 1:12641 N 70TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5313
Practice Address - Country:US
Practice Address - Phone:602-279-2400
Practice Address - Fax:602-279-5890
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ880577Medicaid