Provider Demographics
NPI:1770178311
Name:GILLMAN, DANIELLE SARAH
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:SARAH
Last Name:GILLMAN
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 1:3891 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6216
Mailing Address - Country:US
Mailing Address - Phone:954-774-0469
Mailing Address - Fax:
Practice Address - Street 1:3891 STIRLING RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6216
Practice Address - Country:US
Practice Address - Phone:954-774-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician