MEDICARE: DR. FRED A DANIELE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	013727	NY

General Provider Information

NPI Number	:	1093863227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED A DANIELE PH.D.

Provider Business Mailing Address
First Line	:	270 5TH ST
Second Line	:	4D
City	:	BROOKLYN
State	:	NY
Zip	:	11215-7418
Country	:	US
Telephone Number	:	718-499-2772
Fax Number	:

Provider Business Practice Location Address
First Line	:	567 9TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-4205
Country	:	US
Telephone Number	:	917-907-2772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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