Provider Demographics
NPI:1104907971
Name:DANIERE, JYOTI MICHELE (LCMHC)
Entity type:Individual
Prefix:MS
First Name:JYOTI
Middle Name:MICHELE
Last Name:DANIERE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CLYDE ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3909
Mailing Address - Country:US
Mailing Address - Phone:617-657-9256
Mailing Address - Fax:
Practice Address - Street 1:16 CLYDE ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3909
Practice Address - Country:US
Practice Address - Phone:617-657-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2014-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000096101YM0800X
MA9069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007427Medicaid
VT095181OtherVALUE OPTIONS
VT180007OtherBCBSVT
VT63V241OtherMVP