MEDICARE: MRS. DANIELLE FROMMER B.C.B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	000622-1	NY

General Provider Information

NPI Number	:	1073904447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE FROMMER B.C.B.A.

Provider Business Mailing Address
First Line	:	311 BOWIE ST APT 1903
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-0062
Country	:	US
Telephone Number	:	516-424-1089
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 BOWIE ST APT 1903
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703
Country	:	US
Telephone Number	:	516-424-1089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	09/07/2018

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