Provider Demographics
NPI:1598423717
Name:PALM, DANIELLE STEFANI
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:STEFANI
Last Name:PALM
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 1:126 S MAYNARD ST
Mailing Address - Street 2:
Mailing Address - City:S WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-6927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 S MAYNARD ST
Practice Address - Street 2:
Practice Address - City:S WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-6927
Practice Address - Country:US
Practice Address - Phone:203-535-6803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician