MEDICARE: DANIELLE ANDERSON LCSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1326577594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ANDERSON LCSW

Provider Business Mailing Address
First Line	:	1110 COWAN RD STE B
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-3441
Country	:	US
Telephone Number	:	985-224-5140
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-916-5102
Fax Number	:

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

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	02/05/2026

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