Provider Demographics
NPI:1083234447
Name:RYNCZAK, DANIELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:RYNCZAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FRONGILLO FARM RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1777
Mailing Address - Country:US
Mailing Address - Phone:217-898-3347
Mailing Address - Fax:
Practice Address - Street 1:361 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2323
Practice Address - Country:US
Practice Address - Phone:774-420-3131
Practice Address - Fax:774-420-3122
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11113103TC0700X, 103TF0200X
IL071008764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical