Provider Demographics
NPI:1376837096
Name:METTERVILLE, DANIELLE RENEE (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:RENEE
Last Name:METTERVILLE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CAMBRIDGE STREET, SIMCHES BUILDING 5236
Mailing Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-0580
Mailing Address - Fax:617-724-9620
Practice Address - Street 1:185 CAMBRIDGE STREET, SIMCHES BUILDING 5236
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-0580
Practice Address - Fax:617-724-9620
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC142170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS