Healthcare Provider Details

I. General information

NPI: 1922726454
Provider Name (Legal Business Name): KEVIN PETERSON DANIELS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S WALNUT ST
MILFORD DE
19963-1954
US

IV. Provider business mailing address

2206 OLD EMMORTON RD STE 100
BEL AIR MD
21015-6198
US

V. Phone/Fax

Practice location:
  • Phone: 302-751-2003
  • Fax: 302-570-4664
Mailing address:
  • Phone: 302-470-6661
  • Fax: 302-570-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012323
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: