Provider Demographics
NPI:1982450599
Name:DECARO, DANIELLA
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:DECARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:ELDORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80025-0333
Mailing Address - Country:US
Mailing Address - Phone:845-264-7246
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 333
Practice Address - Street 2:
Practice Address - City:ELDORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80025-0333
Practice Address - Country:US
Practice Address - Phone:845-264-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health