Provider Demographics
NPI:1568205292
Name:MAGNO, DANIELLE KAYLA
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KAYLA
Last Name:MAGNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 RAFFAELE DR
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-0313
Mailing Address - Country:US
Mailing Address - Phone:339-224-1167
Mailing Address - Fax:
Practice Address - Street 1:144 NORTH RD STE 3450
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1183
Practice Address - Country:US
Practice Address - Phone:978-291-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health