Provider Demographics
NPI:1346638988
Name:KOVAC, DANIELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:KOVAC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:864 GRAND AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109
Mailing Address - Country:US
Mailing Address - Phone:860-977-0722
Mailing Address - Fax:
Practice Address - Street 1:864 GRAND AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109
Practice Address - Country:US
Practice Address - Phone:860-977-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA797521041C0700X
CT89311041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid