Provider Demographics
NPI:1952914335
Name:LANDAU, DANIELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LANDAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W 96TH ST APT 12E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6482
Mailing Address - Country:US
Mailing Address - Phone:917-843-3079
Mailing Address - Fax:
Practice Address - Street 1:127 W 96TH ST APT 12E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6482
Practice Address - Country:US
Practice Address - Phone:917-843-3079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical