Provider Demographics
NPI:1093005282
Name:FAIRBAIRN-BLAND, DANIELLE A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:A
Last Name:FAIRBAIRN-BLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:237 FLATBUSH AVE
Mailing Address - Street 2:SUITE 513
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-5224
Mailing Address - Country:US
Mailing Address - Phone:347-450-3876
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST
Practice Address - Street 2:SUITE 1009
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-0103
Practice Address - Country:US
Practice Address - Phone:917-620-0722
Practice Address - Fax:917-620-0722
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0830871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical