Individual
DANIELLE ANDREE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW-CC
Contact information
Practice address
100 GANNETT DR, SOUTH PORTLAND, ME 04106-5900
(207) 854-1030
(207) 899-4623
Mailing address
PO BOX 7044, CAPE PORPOISE, ME 04014-7044
(910) 742-3771
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MC18207
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
MAINECARE
ME
Enumeration date
11/04/2019
Last updated
11/27/2023
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