Healthcare Provider Details

I. General information

NPI: 1033569678
Provider Name (Legal Business Name): DANIEL STEVENS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CUNNINGHAM WAY
DANVILLE KY
40422-8339
US

IV. Provider business mailing address

400 CUNNINGHAM WAY
DANVILLE KY
40422-8339
US

V. Phone/Fax

Practice location:
  • Phone: 859-936-3492
  • Fax: 859-936-3529
Mailing address:
  • Phone: 859-936-3492
  • Fax: 859-936-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5032016
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: