Provider Demographics
NPI:1962701995
Name:MARCONI, DANIELLE ANN
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:ANN
Last Name:MARCONI
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 1:60 LESLIE RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2050
Mailing Address - Country:US
Mailing Address - Phone:203-727-9598
Mailing Address - Fax:
Practice Address - Street 1:60 LESLIE RD
Practice Address - Street 2:UNIT A
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2050
Practice Address - Country:US
Practice Address - Phone:203-727-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional