Provider Demographics
NPI:1831584630
Name:MANDUJANO, DANIELLE CHARLENE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CHARLENE
Last Name:MANDUJANO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:CHARLENE
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7 FAIRWAY CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-3770
Mailing Address - Country:US
Mailing Address - Phone:302-494-3397
Mailing Address - Fax:
Practice Address - Street 1:1019 MATTLIND WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5369
Practice Address - Country:US
Practice Address - Phone:302-459-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00013481041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty