Provider Demographics
NPI:1255700217
Name:DUDEK, DANIELLE (LMSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DUDEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23965 NOVI RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3232
Mailing Address - Country:US
Mailing Address - Phone:248-344-7420
Mailing Address - Fax:248-344-7423
Practice Address - Street 1:23965 NOVI RD STE 110
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3232
Practice Address - Country:US
Practice Address - Phone:248-344-7420
Practice Address - Fax:248-344-7423
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010955131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical