Provider Demographics
NPI:1184873531
Name:PEPE, DANIELLE (LMSW, PHD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PEPE
Suffix:
Gender:F
Credentials:LMSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 161ST ST
Mailing Address - Street 2:2C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3600
Mailing Address - Country:US
Mailing Address - Phone:917-951-8486
Mailing Address - Fax:
Practice Address - Street 1:4612 161ST ST
Practice Address - Street 2:2C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3600
Practice Address - Country:US
Practice Address - Phone:917-951-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065517-1104100000X
NY020177103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker