Provider Demographics
NPI:1144632332
Name:WILMOT, DANNIELLE S (LSW)
Entity type:Individual
Prefix:MRS
First Name:DANNIELLE
Middle Name:S
Last Name:WILMOT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:DANNIELLE
Other - Middle Name:S
Other - Last Name:HAFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1838 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2122
Mailing Address - Country:US
Mailing Address - Phone:570-241-4731
Mailing Address - Fax:
Practice Address - Street 1:616 MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1871
Practice Address - Country:US
Practice Address - Phone:570-540-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130715104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker