Healthcare Provider Details

I. General information

NPI: 1487902854
Provider Name (Legal Business Name): CAROLINE ANNESI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 NW 1ST AVE APT 205
FORT LAUDERDALE FL
33301-3382
US

IV. Provider business mailing address

411 NW 1ST AVE APT 205
FORT LAUDERDALE FL
33301-3382
US

V. Phone/Fax

Practice location:
  • Phone: 954-703-8199
  • Fax:
Mailing address:
  • Phone: 954-703-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12580912
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: