Healthcare Provider Details

I. General information

NPI: 1740569714
Provider Name (Legal Business Name): DANIELLE C KUDELA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE C DEMUNDA LMSW

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 CREEK RD
YOUNGSTOWN NY
14174-9609
US

IV. Provider business mailing address

4061 CREEK RD
YOUNGSTOWN NY
14174-9609
US

V. Phone/Fax

Practice location:
  • Phone: 716-754-8281
  • Fax: 716-286-7876
Mailing address:
  • Phone: 716-754-8281
  • Fax: 716-286-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00083453
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number00081766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: