MEDICARE: MR. DANIEL H CRANDALL MS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871611129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL H CRANDALL MS

Provider Business Mailing Address
First Line	:	2 SWAN AVE
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-6018
Country	:	US
Telephone Number	:	386-689-4543
Fax Number	:	866-463-9550

Provider Business Practice Location Address
First Line	:	2 SWAN AVE
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-6018
Country	:	US
Telephone Number	:	386-689-4543
Fax Number	:	866-463-9550

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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