Provider Demographics
NPI:1073207429
Name:UNDERWOOD, DANEAH R
Entity Type:Individual
Prefix:
First Name:DANEAH
Middle Name:R
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2114
Mailing Address - Country:US
Mailing Address - Phone:626-797-1124
Mailing Address - Fax:
Practice Address - Street 1:225 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2114
Practice Address - Country:US
Practice Address - Phone:626-797-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)