Provider Demographics
NPI:1780259499
Name:NODIFF, DANIEL D (LMHC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:NODIFF
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1650 SYCAMORE AVENUE
Mailing Address - Street 2:#39
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716
Mailing Address - Country:US
Mailing Address - Phone:631-758-8290
Mailing Address - Fax:631-333-7888
Practice Address - Street 1:1650 SYCAMORE AVENUE
Practice Address - Street 2:#39
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716
Practice Address - Country:US
Practice Address - Phone:631-758-8290
Practice Address - Fax:631-333-7888
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY013717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health