Provider Demographics
NPI:1760712129
Name:CLARKE, DANIELLE A (LICSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:A
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ASYLUM ST.
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:07757
Mailing Address - Country:US
Mailing Address - Phone:508-478-6888
Mailing Address - Fax:508-478-9042
Practice Address - Street 1:10 ASYLUM ST.
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:07757
Practice Address - Country:US
Practice Address - Phone:508-478-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2016-02-24
Deactivation Date:2015-01-07
Deactivation Code:
Reactivation Date:2015-01-28
Provider Licenses
StateLicense IDTaxonomies
MA1163951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical