Basic Information
| Provider Information | |||||||||
| NPI: | 1417372160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATIAS | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | LUZ | ||||||||
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| Credential: | MA, MHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 PAYSON AVE | ||||||||
| Address2: | 5I | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100342703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462042295 | ||||||||
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| Practice Location | |||||||||
| Address1: | 579 COURTLANDT AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184852100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2014 | ||||||||
| LastUpdateDate: | 03/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.