Basic Information
Provider Information
NPI: 1912143058
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DANKO
FirstName: MAERUSHKA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: LMSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 21 POINT ST
Address2:  
City: NEW HAMBURG
State: NY
PostalCode: 125905527
CountryCode: US
TelephoneNumber: 8452981922
FaxNumber:  
Practice Location
Address1: 2094 ALBANY POST RD
Address2: B28, RM. 321
City: MONTROSE
State: NY
PostalCode: 105481454
CountryCode: US
TelephoneNumber: 9147374400
FaxNumber: 9147884293
Other Information
ProviderEnumerationDate: 12/19/2008
LastUpdateDate: 12/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X077670NYY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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