Provider Demographics
NPI:1255224945
Name:FALLACARA, JEAN (PHD)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:
Last Name:FALLACARA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 BRICKELL AVE APT 1411
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2778
Mailing Address - Country:US
Mailing Address - Phone:781-732-7203
Mailing Address - Fax:781-732-7203
Practice Address - Street 1:495 BRICKELL AVE APT 1411
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2778
Practice Address - Country:US
Practice Address - Phone:781-732-7203
Practice Address - Fax:781-732-7203
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional