Provider Demographics
NPI:1396266938
Name:DANIELS, JULIETTE W (LICSW)
Entity type:Individual
Prefix:
First Name:JULIETTE
Middle Name:W
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 CHESTNUT STREET
Mailing Address - Street 2:CHILD AND FAMILY SERVICES
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-518-4121
Mailing Address - Fax:603-668-6260
Practice Address - Street 1:464 CHESTNUT STREET
Practice Address - Street 2:CHILD AND FAMILY SERVICES
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-518-4121
Practice Address - Fax:603-668-6260
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008049Medicaid