Provider Demographics
NPI:1104030949
Name:DANIELS, ANNE LACY (ANNE DANIELS, EDD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:LACY
Last Name:DANIELS
Suffix:
Gender:F
Credentials:ANNE DANIELS, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1735
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-7735
Mailing Address - Country:US
Mailing Address - Phone:617-905-4925
Mailing Address - Fax:
Practice Address - Street 1:44 ROSLYN RD
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1232
Practice Address - Country:US
Practice Address - Phone:617-905-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3936103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist