Provider Demographics
NPI:1861278020
Name:DAROCHA, DANIELLE KIERRA (12524-MH-CC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KIERRA
Last Name:DAROCHA
Suffix:
Gender:F
Credentials:12524-MH-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 UNION ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1141
Mailing Address - Country:US
Mailing Address - Phone:508-317-2323
Mailing Address - Fax:
Practice Address - Street 1:25 UNION ST STE 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1141
Practice Address - Country:US
Practice Address - Phone:508-317-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health