Healthcare Provider Details

I. General information

NPI: 1548492770
Provider Name (Legal Business Name): DANIELLE ELIZABETH PECORARO MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 SAINT THOMAS DRIVE
OAK PARK CA
91377-5550
US

IV. Provider business mailing address

334 SAINT THOMAS DR
OAK PARK CA
91377-5550
US

V. Phone/Fax

Practice location:
  • Phone: 818-597-0933
  • Fax:
Mailing address:
  • Phone: 818-597-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: