Provider Demographics
NPI:1699293324
Name:WISCOVITCH, DANIEL JOSEPH (LMSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:WISCOVITCH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2219
Mailing Address - Country:US
Mailing Address - Phone:607-353-0855
Mailing Address - Fax:
Practice Address - Street 1:6 PATCH RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-5631
Practice Address - Country:US
Practice Address - Phone:607-648-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100952-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool