Provider Demographics
NPI:1962243139
Name:DANIELS, CAROLYN LOUISE (PHD, LCSW, CT)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:LOUISE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PHD, LCSW, CT
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:BURGE
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:609 SE 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2530
Mailing Address - Country:US
Mailing Address - Phone:239-770-1510
Mailing Address - Fax:
Practice Address - Street 1:609 SE 21ST ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2530
Practice Address - Country:US
Practice Address - Phone:239-770-1510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical