Healthcare Provider Details

I. General information

NPI: 1912733395
Provider Name (Legal Business Name): DANIELLE LEIGH DAWIDOWICZ LCSW
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 300
BURBANK CA
91505-4556
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 300
BURBANK CA
91505-4556
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: