Healthcare Provider Details

I. General information

NPI: 1265482491
Provider Name (Legal Business Name): SENIOR CONNECTIONS PSYCHOLOGICAL SE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 RIVERSIDE DR. #201
JOHNSON CITY NY
13790
US

IV. Provider business mailing address

P.O. BOX 130926
SPRING TX
77393-0926
US

V. Phone/Fax

Practice location:
  • Phone: 845-781-6061
  • Fax: 607-729-0757
Mailing address:
  • Phone: 281-292-1897
  • Fax: 281-292-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN ALLEN DANIEL
Title or Position: OWNER
Credential: PHD
Phone: 845-781-6061