Provider Demographics
NPI:1548835713
Name:WALDRON, DANIELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 KENILWORTH PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2439
Mailing Address - Country:US
Mailing Address - Phone:347-470-0321
Mailing Address - Fax:
Practice Address - Street 1:108 KENILWORTH PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2439
Practice Address - Country:US
Practice Address - Phone:347-470-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024069-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty