Healthcare Provider Details

I. General information

NPI: 1194573980
Provider Name (Legal Business Name): DANIELLE ALEXIS KASOFF MA, LAC, R-DMT, CTP,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 OLD MARLTON PIKE STE 101
MEDFORD NJ
08055
US

IV. Provider business mailing address

5 HARVEY RD
CREAM RIDGE NJ
08514-1607
US

V. Phone/Fax

Practice location:
  • Phone: 856-223-2222
  • Fax:
Mailing address:
  • Phone: 609-977-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00791700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: