Healthcare Provider Details

I. General information

NPI: 1356982524
Provider Name (Legal Business Name): DANIEL PATRICK CHEATHAM LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

270 BOCES DR
SIDNEY CENTER NY
13839-3105
US

IV. Provider business mailing address

23 SEARLES RD
GROTON NY
13073-9751
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-2520
  • Fax:
Mailing address:
  • Phone: 607-342-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number107311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: