=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982988184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN DANIELS LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2011
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 ELBEL COURT MYERS MIDDLE SCHOOL
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-475-6441
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 CRESCENT VISCHER FERRY RD APT 517
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065-7942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-371-2412
-----------------------------------------------------
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 | 73046353
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------