Provider Demographics
NPI:1972799393
Name:FRAGNITO, DANIELLE DEIDRE (LPC, LISAC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:DEIDRE
Last Name:FRAGNITO
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:DEIDRE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LISAC
Mailing Address - Street 1:1010 E. MCDOWELL RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-955-9059
Mailing Address - Fax:602-955-0165
Practice Address - Street 1:1010 E. MCDOWELL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-955-9059
Practice Address - Fax:602-955-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11214101Y00000X
AZLPC11214101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ251598OtherAHCCCS