Healthcare Provider Details

I. General information

NPI: 1356775456
Provider Name (Legal Business Name): DANIELLE JULIET FICHERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ALAMEDA PARK DR, NE
ALBUQUERQUE NM
87113
US

IV. Provider business mailing address

1264 PEPPOLI LOOP SE
RIO RANCHO NM
87124-8782
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-9911
  • Fax: 505-254-9911
Mailing address:
  • Phone: 505-712-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10404
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: