Provider Demographics
NPI:1104513985
Name:DANIELLE JEDINY-RACIES
Entity type:Organization
Organization Name:DANIELLE JEDINY-RACIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JEDINY-RACIES
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, MA
Authorized Official - Phone:415-335-5970
Mailing Address - Street 1:17802 LITTLE TORCH KY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7689
Mailing Address - Country:US
Mailing Address - Phone:415-335-5970
Mailing Address - Fax:
Practice Address - Street 1:17802 LITTLE TORCH KY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7689
Practice Address - Country:US
Practice Address - Phone:415-335-5970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty