Healthcare Provider Details

I. General information

NPI: 1427197169
Provider Name (Legal Business Name): DANIELLE WEIDLER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BEACON ST APT 8
BROOKLINE MA
02446-4611
US

IV. Provider business mailing address

1555 BEACON ST APT 8
BROOKLINE MA
02446-4611
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-0964
  • Fax: 617-254-5569
Mailing address:
  • Phone: 617-254-0964
  • Fax: 617-254-5569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113140
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: