1831445857 NPI number — DANIELLE MARONICK LICSW

Table of content: DANIELLE MARONICK LICSW (NPI 1831445857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831445857 NPI number — DANIELLE MARONICK LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARONICK
Provider First Name:
DANIELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831445857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2602 W PARKWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99208-6395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-954-3356
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 W BONG ST STE 153
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRCHILD AIR FORCE BASE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99011-9465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-247-4029
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2012

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:  00009607 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00009607 . This is a "LICENSED INDEPENDENT CLINICAL SOCIAL WORKER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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