Basic Information
| Provider Information | |||||||||
| NPI: | 1457476970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANARIELLO | ||||||||
| FirstName: | DENISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 GREEN RIVER LN | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333251246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547328245 | ||||||||
| FaxNumber: | 9547792316 | ||||||||
| Practice Location | |||||||||
| Address1: | 541 GREEN RIVER LN | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333251246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547328245 | ||||||||
| FaxNumber: | 9547792316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 225X00000X | OT14863 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 811647400 | 05 | FL | MEDICAID | 766735300 | 05 | FL | MEDICAID |