Provider Demographics
NPI:1588970529
Name:GAGNE, DANIEL M (CATC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:GAGNE
Suffix:
Gender:M
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2276 ETHEL PORTER DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3226
Mailing Address - Country:US
Mailing Address - Phone:707-225-5766
Mailing Address - Fax:
Practice Address - Street 1:2276 ETHEL PORTER DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3226
Practice Address - Country:US
Practice Address - Phone:707-225-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA091916101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)