Provider Demographics
NPI:1518343490
Name:BEZNICKI, DANIELLA
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:BEZNICKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 UNIVERSITY AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1464
Mailing Address - Country:US
Mailing Address - Phone:917-627-7597
Mailing Address - Fax:
Practice Address - Street 1:1614 UNIVERSITY AVE
Practice Address - Street 2:APT 3
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-1464
Practice Address - Country:US
Practice Address - Phone:917-627-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist