Provider Demographics
NPI:1528678653
Name:HANDELMAN, DANIEL JOSEPH (LICSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:HANDELMAN
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 1:3085 MIDDLEFIELD RD APT 11
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2571
Mailing Address - Country:US
Mailing Address - Phone:847-630-2942
Mailing Address - Fax:781-449-5992
Practice Address - Street 1:3085 MIDDLEFIELD RD APT 11
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2571
Practice Address - Country:US
Practice Address - Phone:847-630-2942
Practice Address - Fax:781-449-5992
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000225973104100000X
MALICSW1260651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALICSW126065Other1041C0700X