Provider Demographics
NPI:1801461165
Name:DUBUQUE, DANIELLE (LICSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DUBUQUE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BOSTON TPKE STE 299
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3602
Mailing Address - Country:US
Mailing Address - Phone:508-641-2067
Mailing Address - Fax:
Practice Address - Street 1:119 BOSTON TPKE STE 299
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3602
Practice Address - Country:US
Practice Address - Phone:508-641-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127408104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker