Provider Demographics
NPI:1750659058
Name:KEISER, DANIELLE BETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:BETH
Last Name:KEISER
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 1:10 SUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5614
Mailing Address - Country:US
Mailing Address - Phone:917-536-6235
Mailing Address - Fax:
Practice Address - Street 1:107 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2337
Practice Address - Country:US
Practice Address - Phone:631-666-1615
Practice Address - Fax:631-666-1709
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0455561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical