1831584630 NPI number — DANIELLE CHARLENE MANDUJANO MSW, LCSW

Table of content: DANIELLE CHARLENE MANDUJANO MSW, LCSW (NPI 1831584630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831584630 NPI number — DANIELLE CHARLENE MANDUJANO MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANDUJANO
Provider First Name:
DANIELLE
Provider Middle Name:
CHARLENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIGGINS
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
CHARLENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831584630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 FAIRWAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19963-3770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-494-3397
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1129 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19963-6418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-422-8026
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  Q1-0001348 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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