Provider Demographics
NPI:1699594226
Name:MCDANIELS, NADINE MARIAH
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:MARIAH
Last Name:MCDANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14428 RAMONA BLVD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3393
Mailing Address - Country:US
Mailing Address - Phone:626-421-5107
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE # A10
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8800
Practice Address - Country:US
Practice Address - Phone:626-349-3838
Practice Address - Fax:855-838-9042
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral