Provider Demographics
NPI:1255790325
Name:TEAGUE-MCDONALD, DANIELLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:TEAGUE-MCDONALD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 NW 29TH MNR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1031
Mailing Address - Country:US
Mailing Address - Phone:813-340-5832
Mailing Address - Fax:
Practice Address - Street 1:5106 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1462
Practice Address - Country:US
Practice Address - Phone:813-340-5832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker