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General NPI Number Information
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NPI Number | 1366960361
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Entity Type | Individual
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Provider Name | DANIEL PAUL GRINBERG LMSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6655 E US HIGHWAY 36
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City | AVON
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State | IN
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Zip | 46123-8923
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Country | US
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Telephone | 888-714-1927
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Fax | 317-745-9565
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Provider Business Mailing Address
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Address Line | 5101 E US HIGHWAY 36 STE 100
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City | AVON
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State | IN
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Zip | 46123-6646
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Country | US
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Telephone | 888-714-1927
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Fax | 317-745-9565
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 99081384A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34008658A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801107398
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License Number State | MI
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