Provider Demographics
NPI:1609054964
Name:ST-PIERRE, DANIELLE T (LICSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:T
Last Name:ST-PIERRE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:T
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:26 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2827
Mailing Address - Country:US
Mailing Address - Phone:617-591-6398
Mailing Address - Fax:
Practice Address - Street 1:26 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2827
Practice Address - Country:US
Practice Address - Phone:617-591-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical