Healthcare Provider Details

I. General information

NPI: 1396109617
Provider Name (Legal Business Name): DANIELLE DUNNE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 COUNTY HOUSE RD
PENN YAN NY
14527-9317
US

IV. Provider business mailing address

2442 COUNTY HOUSE RD
PENN YAN NY
14527-9317
US

V. Phone/Fax

Practice location:
  • Phone: 732-213-0489
  • Fax:
Mailing address:
  • Phone: 732-213-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00594500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: