Provider Demographics
NPI:1528157864
Name:DELLOSSO, MARGRET ROSE C (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARGRET ROSE
Middle Name:C
Last Name:DELLOSSO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N. UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3618
Mailing Address - Country:US
Mailing Address - Phone:954-435-3683
Mailing Address - Fax:954-435-2263
Practice Address - Street 1:1900 N. UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-435-3683
Practice Address - Fax:954-435-2263
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7515103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY7515OtherLICENSE NUMBER
FLMH4192OtherLICENSE NUMBER