Provider Demographics
NPI:1356780522
Name:SMITH, DANIELLE PEARL (PCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:PEARL
Last Name:SMITH
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WERNER CT STE 205B
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1326
Mailing Address - Country:US
Mailing Address - Phone:307-277-6025
Mailing Address - Fax:605-443-8880
Practice Address - Street 1:800 WERNER CT STE 205B
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1326
Practice Address - Country:US
Practice Address - Phone:307-277-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-9241041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical