Provider Demographics
NPI:1588789440
Name:BILLER NICOLETTI, DALIA (PSYD)
Entity type:Individual
Prefix:
First Name:DALIA
Middle Name:
Last Name:BILLER NICOLETTI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DALIA
Other - Middle Name:
Other - Last Name:SAFFA BILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:8201 TONAWANDA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1896
Mailing Address - Country:US
Mailing Address - Phone:704-582-9884
Mailing Address - Fax:
Practice Address - Street 1:7810 BALLANTYNE COMMONS PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3415
Practice Address - Country:US
Practice Address - Phone:704-582-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3912103TC0700X, 103TC2200X, 103TF0000X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
54587AMedicare ID - Type Unspecified
P23155Medicare UPIN