=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083992457
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA DANIELLE PICCIOTTI MSW, LCSW, C-DBT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2011
-----------------------------------------------------
Last Update Date | 08/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 424 BECK RD
-----------------------------------------------------
City | SOUDERTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18964-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-906-6062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 424 BECK RD
-----------------------------------------------------
City | SOUDERTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18964-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-906-6062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | CW023744
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------