Provider Demographics
NPI:1578918876
Name:DIMITROVA, DANI (LCSW)
Entity Type:Individual
Prefix:
First Name:DANI
Middle Name:
Last Name:DIMITROVA
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 1:204 BRANTLEY HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-1822
Mailing Address - Country:US
Mailing Address - Phone:203-300-3335
Mailing Address - Fax:940-574-4096
Practice Address - Street 1:204 BRANTLEY HARBOR DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-1822
Practice Address - Country:US
Practice Address - Phone:203-300-3335
Practice Address - Fax:940-574-4096
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW170481041C0700X
CT0096201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13817474OtherCAQH
CT060669107OtherUBH- OXFORD FREEDOM/LIBERTY WELLNORE GRP/FACILITY
CT13817474OtherCAQH
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT060669107OtherUBH- UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CTNOT ELIGIBLEOtherMHN TRICARENORTH
CTNOT ELIGIBLEOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE FACILITY/GROUP
CT060669107OtherUBH- CONNECTICARE WELLMORE GRP/FACILITY
CTD339123-WATERBURYOtherBEACON HEALTH STRATEGIES
CTPENDINGMedicaid
CTD339123-WATERBURYOtherBEACON HEALTH STRATEGIES