Provider Demographics
NPI:1407682834
Name:LEDESMA, DANIELLE I
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:I
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 SUMMIT CORNER DR APT 240
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8419
Mailing Address - Country:US
Mailing Address - Phone:203-898-2394
Mailing Address - Fax:
Practice Address - Street 1:4241 SUMMIT CORNER DR APT 240
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8419
Practice Address - Country:US
Practice Address - Phone:203-898-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0805002564103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist