Provider Demographics
NPI:1164704003
Name:CHASE, DANIELLE SUE (LCSW, CASAC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SUE
Last Name:CHASE
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 FREEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9684
Mailing Address - Country:US
Mailing Address - Phone:607-844-6491
Mailing Address - Fax:607-844-3524
Practice Address - Street 1:380 FREEVILLE RD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9684
Practice Address - Country:US
Practice Address - Phone:607-844-6491
Practice Address - Fax:607-844-3524
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29854101YA0400X
NY083916-11041C0700X
NY087091-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1588714265Medicaid