Provider Demographics
NPI:1386121531
Name:FREE, DANIELLE PETROSKY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:PETROSKY
Last Name:FREE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5711
Mailing Address - Country:US
Mailing Address - Phone:434-989-5656
Mailing Address - Fax:
Practice Address - Street 1:1010 EDNAM CTR STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4616
Practice Address - Country:US
Practice Address - Phone:434-989-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176370363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health