Provider Demographics
NPI:1356775456
Name:FICHERA, DANIELLE JULIET (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JULIET
Last Name:FICHERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 PEPPOLI LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8782
Mailing Address - Country:US
Mailing Address - Phone:505-712-2190
Mailing Address - Fax:
Practice Address - Street 1:315 ALAMEDA PARK DR, NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113
Practice Address - Country:US
Practice Address - Phone:505-842-9911
Practice Address - Fax:505-254-9911
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-104041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1356775456Medicaid