Provider Demographics
NPI:1518463819
Name:DANIELA DE SA LCSW LLC
Entity Type:Organization
Organization Name:DANIELA DE SA LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-899-1936
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05689300261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)