Provider Demographics
NPI:1275870438
Name:GUSMEROTTI, DANIELLE CHARITY
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CHARITY
Last Name:GUSMEROTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 CASEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-1818
Mailing Address - Country:US
Mailing Address - Phone:702-524-6797
Mailing Address - Fax:
Practice Address - Street 1:2515 CASEY DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1818
Practice Address - Country:US
Practice Address - Phone:702-524-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst