Provider Demographics
NPI:1588329304
Name:DANIELS, CASIDHE CAITLIN (LCSW)
Entity type:Individual
Prefix:
First Name:CASIDHE
Middle Name:CAITLIN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASIDHE
Other - Middle Name:CAITLIN
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-3420
Mailing Address - Country:US
Mailing Address - Phone:619-548-2212
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC209461041C0700X
FLSW18241041C0700X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical