Provider Demographics
NPI:1518312958
Name:DE SA, DANIELA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:DANIELA
Middle Name:
Last Name:DE SA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3680
Mailing Address - Country:US
Mailing Address - Phone:908-899-1936
Mailing Address - Fax:
Practice Address - Street 1:473 BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3680
Practice Address - Country:US
Practice Address - Phone:908-899-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9618451041S0200X
NJ44SC056893001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool