Provider Demographics
NPI:1629899125
Name:BANFIELD, DANIELLE MARIE AUSTIN (CLC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE AUSTIN
Last Name:BANFIELD
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9508
Mailing Address - Country:US
Mailing Address - Phone:607-351-6409
Mailing Address - Fax:
Practice Address - Street 1:3040 GARRETT RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9508
Practice Address - Country:US
Practice Address - Phone:607-351-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY341432101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor