Provider Demographics
NPI:1528047966
Name:BUFFINGTON, DANIELLE MAE (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MAE
Last Name:BUFFINGTON
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 1:320 INDIGO ST
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1326
Mailing Address - Country:US
Mailing Address - Phone:503-440-3088
Mailing Address - Fax:
Practice Address - Street 1:12 ROOSEVELT AVE STE 5A
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2832
Practice Address - Country:US
Practice Address - Phone:503-440-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT150791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical