Healthcare Provider Details

I. General information

NPI: 1093698755
Provider Name (Legal Business Name): DANIEL JOHN CLANCY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 LEXINGTON AVE
NEW YORK NY
10035-2902
US

IV. Provider business mailing address

208 7TH ST APT 1B
LINDENHURST NY
11757-1100
US

V. Phone/Fax

Practice location:
  • Phone: 646-360-0221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP133741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: