Provider Demographics
NPI:1467944033
Name:COMERFORD, DANIELLE ELISSA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:ELISSA
Last Name:COMERFORD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:ELISSA
Other - Last Name:COMERFORD-WORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DANI WORTH
Mailing Address - Street 1:370 GRAND AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4874
Mailing Address - Country:US
Mailing Address - Phone:510-859-7212
Mailing Address - Fax:
Practice Address - Street 1:370 GRAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610
Practice Address - Country:US
Practice Address - Phone:510-859-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105136106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist