Provider Demographics
NPI:1033569678
Name:STEVENS, DANIEL SR
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STEVENS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CUNNINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8339
Mailing Address - Country:US
Mailing Address - Phone:859-936-3492
Mailing Address - Fax:859-936-3529
Practice Address - Street 1:400 CUNNINGHAM WAY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8339
Practice Address - Country:US
Practice Address - Phone:859-936-3492
Practice Address - Fax:859-936-3529
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50320161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical