Provider Demographics
NPI:1124364351
Name:INNA DANIELI LCSW, LLC
Entity Type:Organization
Organization Name:INNA DANIELI LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-363-6302
Mailing Address - Street 1:416 LYDECKER ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1914
Mailing Address - Country:US
Mailing Address - Phone:917-363-6302
Mailing Address - Fax:
Practice Address - Street 1:1182 TEANECK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4824
Practice Address - Country:US
Practice Address - Phone:917-363-6302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-15
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055278001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ265762Medicare PIN