Basic Information
| Provider Information | |||||||||
| NPI: | 1508179862 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIZRAHI | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 638 WESTERN PARK DR | ||||||||
| Address2: | |||||||||
| City: | WEST HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115522845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162209705 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24302 NORTHERN BLVD | ||||||||
| Address2: | |||||||||
| City: | DOUGLASTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113621150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184236200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2010 | ||||||||
| LastUpdateDate: | 07/18/2016 | ||||||||
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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 | 1041C0700X | 081574 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.