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NPI Code Detail

MEDICARE: MR. DANIEL MCKELVEY PEYSER LICSW

MEDICARE: MR. DANIEL MCKELVEY PEYSER LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker079624-1NY
21041C0700XClinical Social Worker089-0120996VT

General Provider Information

NPI Number : 1477886976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL MCKELVEY PEYSER LICSW
Provider Business Mailing Address
First Line : 102 S WINOOSKI AVE
Second Line :
City : BURLINGTON
State : VT
Zip : 05401-7406
Country : US
Telephone Number : 802-488-6920
Fax Number : 802-488-6919
Provider Business Practice Location Address
First Line : 75 SAN REMO DR
Second Line :
City : SOUTH BURLINGTON
State : VT
Zip : 05403-6385
Country : US
Telephone Number : 802-488-6000
Fax Number : 802-488-6919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2009
Last Update Date : 04/29/2025

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