Healthcare Provider Details

I. General information

NPI: 1982450599
Provider Name (Legal Business Name): DANIELLA DECARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 333
ELDORADO SPRINGS CO
80025-0333
US

IV. Provider business mailing address

PO BOX 333
ELDORADO SPRINGS CO
80025-0333
US

V. Phone/Fax

Practice location:
  • Phone: 845-264-7246
  • Fax:
Mailing address:
  • Phone: 845-264-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0021853
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: