Provider Demographics
NPI:1821743873
Name:KISSEL, DANIELLE (MA, BSL)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KISSEL
Suffix:
Gender:F
Credentials:MA, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 PUTNAM BLVD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6769
Mailing Address - Country:US
Mailing Address - Phone:610-563-7007
Mailing Address - Fax:
Practice Address - Street 1:1314 PUTNAM BLVD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6769
Practice Address - Country:US
Practice Address - Phone:610-563-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 225600000X
PABH002058103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist