Provider Demographics
NPI:1043819618
Name:WELLER, DANIEL IRVIN
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:IRVIN
Last Name:WELLER
Suffix:
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 1:1215 OBRIEN DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1412
Mailing Address - Country:US
Mailing Address - Phone:650-260-3805
Mailing Address - Fax:
Practice Address - Street 1:1215 OBRIEN DR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1412
Practice Address - Country:US
Practice Address - Phone:650-260-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst