=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588800197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISA S DANIEL LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2009
-----------------------------------------------------
Last Update Date | 01/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 621 W MAIN ST
-----------------------------------------------------
City | PURCELLVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20132-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-338-3332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17342 ARROWWOOD PL
-----------------------------------------------------
City | ROUND HILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20141-2487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-338-8109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904006383
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------