Provider Demographics
NPI:1144404815
Name:PROCTOR, DANNIELLE L (MS)
Entity Type:Individual
Prefix:
First Name:DANNIELLE
Middle Name:L
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LAURENS ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2511
Mailing Address - Country:US
Mailing Address - Phone:716-373-8080
Mailing Address - Fax:716-373-8093
Practice Address - Street 1:203 LAURENS ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2511
Practice Address - Country:US
Practice Address - Phone:716-373-8080
Practice Address - Fax:716-373-8093
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor