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General NPI Number Information
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NPI Number | 1649463324
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Entity Type | Individual
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Provider Name | DANIEL E. MATTILA LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 36 W 44TH ST STE 1007
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City | NEW YORK
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State | NY
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Zip | 10036-8106
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Country | US
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Telephone | 212-221-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WALNUT TREE HILL RD
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City | SANDY HOOK
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State | CT
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Zip | 06482-1046
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Country | US
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Telephone | 203-426-9340
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 055640
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License Number State | NY
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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 | 005495
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License Number State | CT
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