Individual provider Active NPI

Danielle Petrella

  • Marriage & Family Therapist
  • Syracuse, NY
National Provider Identifier
1760934764
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
001862-01 Issued in NY
Practice address
1045 James St
Syracuse, NY 13203
Phone
(315) 472-4471
NPI assigned
Oct 26, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 001862-01 NY Primary

Addresses

Primary practice location

1045 James St
Syracuse, NY 13203

Mailing address

1045 James St Ste 100
Syracuse, NY 13203-2758
Phone (315) 472-4471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240206000660 NY Practitioner - Marriage and Family Therapist 5799128872 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Liberty Resources IncGroup PAC ID 4486703352, 82 clinicians

Practice addresses (Care Compare)

1045 James St
Syracuse, NY 13203-2730
Phone 31547244711384

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001862-01NYMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty Resources Inc. CurrentSince Jan 1, 2024 Accepting new patients
Liberty Resources, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

1045 James St
Ste 100
Syracuse, NY 13203
Phone (315) 425-1004

1045 James St
Syracuse, NY 13203
Phone (315) 425-1004

Interoperability endpoints

  • Direct secure messaging: danielle.petrella.p1@direct.liberty-resources.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1760934764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST STE 100",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032758",
            "telephone_number": "315-472-4471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13203",
            "telephone_number": "315-472-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRELLA",
        "first_name": "DANIELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-26",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NY",
            "license": "001862-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.