Healthcare Provider Details

I. General information

NPI: 1316972912
Provider Name (Legal Business Name): DANIEL IAN SCHACHT LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAIN ST STE 202
NATICK MA
01760-4525
US

IV. Provider business mailing address

20 MAIN ST STE 202
NATICK MA
01760-4525
US

V. Phone/Fax

Practice location:
  • Phone: 774-292-9011
  • Fax:
Mailing address:
  • Phone: 774-292-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1030898
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: