Provider Demographics
NPI:1518459247
Name:DESISTO, DANIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DESISTO
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 1:49 NURSERY LN
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3576
Mailing Address - Country:US
Mailing Address - Phone:978-784-5320
Mailing Address - Fax:
Practice Address - Street 1:49 NURSERY LN
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3576
Practice Address - Country:US
Practice Address - Phone:978-784-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226199104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker