Provider Demographics
NPI:1821815937
Name:BOURGEON, DANIELLE ABBEY (MS, LAPC, CRC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ABBEY
Last Name:BOURGEON
Suffix:
Gender:F
Credentials:MS, LAPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2601
Mailing Address - Country:US
Mailing Address - Phone:267-475-0985
Mailing Address - Fax:
Practice Address - Street 1:3550 DARBY RD
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1018
Practice Address - Country:US
Practice Address - Phone:484-580-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
PAAPC000552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty