Provider Demographics
NPI:1386734580
Name:DANIELS, GERARD JOESPH (LICSW)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:JOESPH
Last Name:DANIELS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SLEEPY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2124
Mailing Address - Country:US
Mailing Address - Phone:781-646-4722
Mailing Address - Fax:
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE 407
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:781-771-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1006221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADA-P24015Medicare ID - Type Unspecified