MEDICARE: DANIELLE ROSE LACOSS 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	1041C0700X	Clinical Social Worker	6801098322	MI
2	1041C0700X	Clinical Social Worker	7178	TN

General Provider Information

NPI Number	:	1588326276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ROSE LACOSS LCSW

Provider Business Mailing Address
First Line	:	3323 HARPETH SPRINGS DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-2392
Country	:	US
Telephone Number	:	269-217-2108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3323 HARPETH SPRINGS DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-2392
Country	:	US
Telephone Number	:	269-217-2108
Fax Number	:

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

Provider Enumeration Date	:	10/10/2021
Last Update Date	:	10/10/2021

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