Provider Demographics
NPI:1225473903
Name:ADELGLASS, DANIELLE ROSE (MS)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ROSE
Last Name:ADELGLASS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:ROSE
Other - Last Name:BORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:486 DEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-2102
Mailing Address - Country:US
Mailing Address - Phone:631-241-3055
Mailing Address - Fax:
Practice Address - Street 1:25 LITTLE PLAINS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4550
Practice Address - Country:US
Practice Address - Phone:631-266-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool