Provider Demographics
NPI:1346301710
Name:PETTIFORD, DANIELLE MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:PETTIFORD
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 1:53 H FOOTE RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507
Mailing Address - Country:US
Mailing Address - Phone:508-434-0041
Mailing Address - Fax:
Practice Address - Street 1:340 MAIN ST
Practice Address - Street 2:SUITE 383
Practice Address - City:WORESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-791-4976
Practice Address - Fax:508-791-6723
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health