Basic Information
| Provider Information | |||||||||
| NPI: | 1427383488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARYOTT | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DIXON | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 50 DEEPWOOD ROAD | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039790858 | ||||||||
| FaxNumber: | 2036292940 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 MAIN STREET NO. 8 SUITE B | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036292822 | ||||||||
| FaxNumber: | 2036292940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 02/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.