Provider Demographics
NPI:1598505042
Name:FALLISI, ANNA RITA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:RITA
Last Name:FALLISI
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 1:109 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-2948
Mailing Address - Country:US
Mailing Address - Phone:603-401-3736
Mailing Address - Fax:
Practice Address - Street 1:41 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-3545
Practice Address - Country:US
Practice Address - Phone:978-206-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-24-73108103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst