Provider Demographics
NPI:1548384506
Name:DANNER, GINA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:C
Last Name:DANNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 INMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-1433
Mailing Address - Country:US
Mailing Address - Phone:732-396-1444
Mailing Address - Fax:732-574-3435
Practice Address - Street 1:811 INMAN AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-1433
Practice Address - Country:US
Practice Address - Phone:732-396-1444
Practice Address - Fax:732-574-3435
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100439200103TC0700X
NY016286-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ292629CBHMedicare PIN