Provider Demographics
NPI:1104222751
Name:DANIELS, NICHOLAS
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DANIELS
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 1:2633 TUSKY VALLEY RD NE
Mailing Address - Street 2:
Mailing Address - City:ZOARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44656-9692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2633 TUSKY VALLEY RD NE
Practice Address - Street 2:
Practice Address - City:ZOARVILLE
Practice Address - State:OH
Practice Address - Zip Code:44656-9692
Practice Address - Country:US
Practice Address - Phone:330-859-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool