Provider Demographics
NPI:1831927227
Name:QVISTGAARD, DANIELLA (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:QVISTGAARD
Suffix:
Gender:X
Credentials:LCSW
Other - Prefix:
Other - First Name:FRANKY
Other - Middle Name:
Other - Last Name:QVISTGAARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:992 GREAT PLAIN AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:992 GREAT PLAIN AVE STE 22
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2524
Practice Address - Country:US
Practice Address - Phone:781-400-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2308071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical