=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528157864
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGRET ROSE C. DELLOSSO PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 08/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 N. UNIVERSITY DRIVE SUITE 103
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-435-3683
-----------------------------------------------------
Fax | 954-435-2263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 N. UNIVERSITY DRIVE SUITE 103
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-435-3683
-----------------------------------------------------
Fax | 954-435-2263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY7515
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------