Provider Demographics
NPI:1407953185
Name:DANIELS, DONNA (LICSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
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 1:162 PRESERVATION WAY
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8237
Mailing Address - Country:US
Mailing Address - Phone:401-484-6812
Mailing Address - Fax:
Practice Address - Street 1:162 PRESERVATION WAY
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-8237
Practice Address - Country:US
Practice Address - Phone:401-484-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1071591041C0700X
RIISW005401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1021400OtherBEACON
RI406363OtherBLUE CHIP
RI62-31150OtherUNITED HEALTH CARE
RI9438-0OtherBLUE CROSS/BLUE SHIELD
MA268677OtherMAGELLLAN
RI62-31150OtherUNITED HEALTH CARE