Healthcare Provider Details

I. General information

NPI: 1508179862
Provider Name (Legal Business Name): DANIELLE M MIZRAHI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24302 NORTHERN BLVD
DOUGLASTON NY
11362-1150
US

IV. Provider business mailing address

638 WESTERN PARK DR
WEST HEMPSTEAD NY
11552-2845
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-6200
  • Fax:
Mailing address:
  • Phone: 516-220-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: