=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407503113
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JODI DANIEL LCSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2022
-----------------------------------------------------
Last Update Date | 03/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 W 147TH ST APT 3
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10031-0782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-626-6020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 428 W 147TH ST APT 3
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10031-0782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-626-6020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JODI DANIEL
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 269-626-6020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------