Healthcare Provider Details

I. General information

NPI: 1013892454
Provider Name (Legal Business Name): MR. DANTE DALLI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

566 BAY RIDGE PKWY BSMT
BROOKLYN NY
11209-3310
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax:
Mailing address:
  • Phone: 617-899-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP136707
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: