Provider Demographics
NPI:1639662067
Name:RISBY, DANIELLE (THERAPIST)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:RISBY
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:FOSSELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:THERAPIST
Mailing Address - Street 1:624 MARKET AVE N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1017
Mailing Address - Country:US
Mailing Address - Phone:330-493-4553
Mailing Address - Fax:330-493-3761
Practice Address - Street 1:624 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1017
Practice Address - Country:US
Practice Address - Phone:330-493-4553
Practice Address - Fax:330-493-3761
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS20048331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator