Provider Demographics
NPI:1831445857
Name:MARONICK, DANIELLE (LICSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MARONICK
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 1:2602 W PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6395
Mailing Address - Country:US
Mailing Address - Phone:509-954-3356
Mailing Address - Fax:
Practice Address - Street 1:220 W BONG ST STE 153
Practice Address - Street 2:
Practice Address - City:FAIRCHILD AIR FORCE BASE
Practice Address - State:WA
Practice Address - Zip Code:99011-9465
Practice Address - Country:US
Practice Address - Phone:509-247-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000096071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00009607OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER