Healthcare Provider Details

I. General information

NPI: 1659912830
Provider Name (Legal Business Name): BRONWYN ELIZABETH MCDANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BREWSTER CT
NORTHAMPTON MA
01060-3801
US

IV. Provider business mailing address

2200 DAM RD
FORT MILL SC
29708-8475
US

V. Phone/Fax

Practice location:
  • Phone: 413-587-3265
  • Fax: 413-587-3268
Mailing address:
  • Phone: 803-984-1748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: