Provider Demographics
NPI:1083374342
Name:MENDELSOHN, DANIEL G (LICSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 JUGGLER MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9521
Mailing Address - Country:US
Mailing Address - Phone:617-304-0094
Mailing Address - Fax:
Practice Address - Street 1:51 JUGGLER MEADOW RD
Practice Address - Street 2:
Practice Address - City:LEVERETT
Practice Address - State:MA
Practice Address - Zip Code:01054-9521
Practice Address - Country:US
Practice Address - Phone:617-304-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool