MEDICARE: MS. ANITA ANTOINETTE DANIELS LCSW

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
1	1041C0700X	Clinical Social Worker	C005297	NC

General Provider Information

NPI Number	:	1750309753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA ANTOINETTE DANIELS LCSW

Provider Business Mailing Address
First Line	:	102 NUTTREE WAY
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-9079
Country	:	US
Telephone Number	:	919-403-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 N DUKE ST STE 900
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-3019
Country	:	US
Telephone Number	:	919-313-0260
Fax Number	:	919-313-0299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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