Provider Demographics
NPI:1124772827
Name:RADOM, DANIEL VINCENT (MS, MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:VINCENT
Last Name:RADOM
Suffix:
Gender:M
Credentials:MS, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 STICKLES POND RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2813
Mailing Address - Country:US
Mailing Address - Phone:973-383-8670
Mailing Address - Fax:973-383-8676
Practice Address - Street 1:93 STICKLES POND RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2813
Practice Address - Country:US
Practice Address - Phone:973-383-8670
Practice Address - Fax:973-383-8676
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL066328001041C0700X, 261QM0801X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)