Provider Demographics
NPI:1124392519
Name:RUSSO, DANIELLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BAYONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:134 BAY 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 BAY 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3703
Practice Address - Country:US
Practice Address - Phone:347-893-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073655104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker