Provider Demographics
NPI:1215518618
Name:PHILLIPS, DANIEL PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PAUL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4338
Mailing Address - Country:US
Mailing Address - Phone:510-547-7492
Mailing Address - Fax:
Practice Address - Street 1:970 KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94611-4338
Practice Address - Country:US
Practice Address - Phone:510-547-7492
Practice Address - Fax:510-547-7492
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW914631041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty