Provider Demographics
NPI:1336927938
Name:GERSH, DANIELLE SHANI
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHANI
Last Name:GERSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 DESERT SAGE CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7234
Mailing Address - Country:US
Mailing Address - Phone:805-208-7091
Mailing Address - Fax:
Practice Address - Street 1:3235 DESERT SAGE CT
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7234
Practice Address - Country:US
Practice Address - Phone:805-208-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist