Provider Demographics
NPI:1437760071
Name:GOFMAN, DANIELLE (MA, LPC, C-DBT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GOFMAN
Suffix:
Gender:F
Credentials:MA, LPC, C-DBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 PARK AVE UNIT 29
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1356
Mailing Address - Country:US
Mailing Address - Phone:724-601-7222
Mailing Address - Fax:
Practice Address - Street 1:2675 PARK AVE UNIT 29
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1356
Practice Address - Country:US
Practice Address - Phone:724-601-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health