Provider Demographics
NPI:1306535992
Name:WENGER, DANIEL HARRIS (MT-BC, LCAT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:HARRIS
Last Name:WENGER
Suffix:
Gender:M
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LILY POND DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-2247
Mailing Address - Country:US
Mailing Address - Phone:646-633-3442
Mailing Address - Fax:
Practice Address - Street 1:21 LILY POND DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-2247
Practice Address - Country:US
Practice Address - Phone:646-633-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002698225A00000X
16029225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist