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General NPI Number Information
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NPI Number | 1477023950
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Entity Type | Individual
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Provider Name | DANIELLE LEE RUQUET LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 44210 RT. 48 NORTH ROAD
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City | SOUTHOLD
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State | NY
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Zip | 11971
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Country | US
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Telephone | 631-294-5299
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Fax |
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Provider Business Mailing Address
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Address Line | 7 CHAPEL PL
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-5711
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Country | US
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Telephone | 631-294-5299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 009169
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License Number State | NY
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