Provider Demographics
NPI:1073875548
Name:MEISENHEIMER, DANIEL DAVID
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DAVID
Last Name:MEISENHEIMER
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 1:1042 62ND ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2322
Mailing Address - Country:US
Mailing Address - Phone:415-240-9077
Mailing Address - Fax:
Practice Address - Street 1:1042 62ND ST UNIT B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2322
Practice Address - Country:US
Practice Address - Phone:415-240-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA602971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker