Provider Demographics
NPI:1194049304
Name:RICH, DANIELLE MARISA (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:MARISA
Last Name:RICH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2829
Mailing Address - Country:US
Mailing Address - Phone:516-610-3646
Mailing Address - Fax:
Practice Address - Street 1:103 N 3RD ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2829
Practice Address - Country:US
Practice Address - Phone:516-610-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58018319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist