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General NPI Number Information
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NPI Number | 1528047966
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Entity Type | Individual
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Provider Name | DANIELLE MAE BUFFINGTON LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 12 ROOSEVELT AVE STE 5A
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City | MYSTIC
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State | CT
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Zip | 06355-2832
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Country | US
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Telephone | 503-440-3088
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Fax |
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Provider Business Mailing Address
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Address Line | 320 INDIGO ST
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City | MYSTIC
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State | CT
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Zip | 06355-1326
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Country | US
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Telephone | 503-440-3088
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15079
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License Number State | CT
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