Provider Demographics
NPI:1174724322
Name:DESANTIS, DANIELLE L (CP, LMFT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:CP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 NE 31ST ST UNIT 3102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4592
Mailing Address - Country:US
Mailing Address - Phone:401-371-0223
Mailing Address - Fax:401-217-3612
Practice Address - Street 1:480 NE 31ST ST UNIT 3102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4592
Practice Address - Country:US
Practice Address - Phone:401-371-0223
Practice Address - Fax:401-217-3612
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11093103TC0700X
101Y00000X
RIPS01861103TC0700X
RI00144106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30343OtherBLUE CROSS CRISIS