Provider Demographics
NPI:1194573980
Name:KASOFF, DANIELLE ALEXIS (MA, LAC, R-DMT, CTP,)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALEXIS
Last Name:KASOFF
Suffix:
Gender:F
Credentials:MA, LAC, R-DMT, CTP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-1607
Mailing Address - Country:US
Mailing Address - Phone:609-977-0811
Mailing Address - Fax:
Practice Address - Street 1:103 OLD MARLTON PIKE STE 101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055
Practice Address - Country:US
Practice Address - Phone:856-223-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00791700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor