Provider Demographics
NPI:1437045218
Name:PAEZ, DANIELLE VICTORIA (LICSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:VICTORIA
Last Name:PAEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:VICTORIA
Other - Last Name:DOS SANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5340
Mailing Address - Country:US
Mailing Address - Phone:508-208-7303
Mailing Address - Fax:
Practice Address - Street 1:320 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5340
Practice Address - Country:US
Practice Address - Phone:508-208-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW128315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health