Healthcare Provider Details

I. General information

NPI: 1790468619
Provider Name (Legal Business Name): DANIELLE GINA MAINARDI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTH AVE E # 2
WESTFIELD NJ
07090-1457
US

IV. Provider business mailing address

506 W MOUNT PLEASANT AVE STE 1050
LIVINGSTON NJ
07039-1701
US

V. Phone/Fax

Practice location:
  • Phone: 732-646-8364
  • Fax:
Mailing address:
  • Phone: 732-646-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ14893900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: