Provider Demographics
NPI:1407193675
Name:SMALL, DANIELLE ROBIN (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ROBIN
Last Name:SMALL
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 WAVERLY DR APT 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2779
Mailing Address - Country:US
Mailing Address - Phone:917-405-9146
Mailing Address - Fax:
Practice Address - Street 1:191 ARGONNE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3231
Practice Address - Country:US
Practice Address - Phone:562-434-6007
Practice Address - Fax:562-856-2370
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist