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Individual
DANIELLE PROVINO
Active
Individual
DANIELLE PROVINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
080205
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00355940
AGENCY MEDICAID #
NY
01
—
1285628552
AGENCY NPI #
NY
Enumeration date
01/17/2007
Last updated
03/01/2013
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