Healthcare Provider Details

I. General information

NPI: 1639294051
Provider Name (Legal Business Name): DANIEL EDWARD HUTT DSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 PUMPKIN ST
EAST NORTHPORT NY
11731-4315
US

IV. Provider business mailing address

37 PUMPKIN ST
EAST NORTHPORT NY
11731-4315
US

V. Phone/Fax

Practice location:
  • Phone: 631-368-5105
  • Fax: 631-368-5105
Mailing address:
  • Phone: 631-368-5105
  • Fax: 631-368-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR028270
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: