Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 017562 | NY |
NPI | 1225209448 |
---|---|
Provider Name | Ms. Danielle M Shallcross |
First Address | Brooklyn, NY 11220-3702 |
Second Address | Brooklyn, NY 11220-2010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2008 |
Last Update Date | 14/03/2008 |