Healthcare Provider Details

I. General information

NPI: 1760219380
Provider Name (Legal Business Name): DANIELLE K SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 KENNETT PIKE # 988
WILMINGTON DE
19807-2018
US

IV. Provider business mailing address

68 MISTY MEADOW DR
MAGNOLIA DE
19962-1724
US

V. Phone/Fax

Practice location:
  • Phone: 484-577-9928
  • Fax:
Mailing address:
  • Phone: 302-698-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-299167
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: