Provider Demographics
NPI:1699553735
Name:HANEY, KODI DANIEL
Entity type:Individual
Prefix:
First Name:KODI
Middle Name:DANIEL
Last Name:HANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ATLANTIC AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5824
Mailing Address - Country:US
Mailing Address - Phone:845-549-2813
Mailing Address - Fax:
Practice Address - Street 1:322 ATLANTIC AVE APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5824
Practice Address - Country:US
Practice Address - Phone:845-549-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical