Provider Demographics
NPI:1649951492
Name:ST VALLIERE, DAPHNE (LMSW)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:ST VALLIERE
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 1:408 W 145TH ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-5202
Mailing Address - Country:US
Mailing Address - Phone:347-577-2306
Mailing Address - Fax:
Practice Address - Street 1:273 W 138TH ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2167
Practice Address - Country:US
Practice Address - Phone:347-577-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY257754104100000X
NY102235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker