=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003548785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELLE NANETTE GREENE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2022
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14645 NW 77TH AVE STE 101
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-769-3524
-----------------------------------------------------
Fax | 786-206-5877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14645 NW 77TH AVE STE 101
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-769-3524
-----------------------------------------------------
Fax | 786-206-5877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW20058
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------