Provider Demographics
NPI:1093863227
Name:DANIELE, FRED A (PHD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:A
Last Name:DANIELE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 5TH ST
Mailing Address - Street 2:4D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7418
Mailing Address - Country:US
Mailing Address - Phone:718-499-2772
Mailing Address - Fax:
Practice Address - Street 1:567 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4205
Practice Address - Country:US
Practice Address - Phone:917-907-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013727103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist