Provider Demographics
NPI:1326578907
Name:BERCOVITCH, DANIELLE D (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:D
Last Name:BERCOVITCH
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:GABBAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 MARKET ST UNIT 2907
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1366
Mailing Address - Country:US
Mailing Address - Phone:856-495-5280
Mailing Address - Fax:
Practice Address - Street 1:1930 S BROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:856-495-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist