Provider Demographics
NPI:1154487049
Name:JONES, DANIEL BRADLEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRADLEY
Last Name:JONES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W 10TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3178
Mailing Address - Country:US
Mailing Address - Phone:212-255-4742
Mailing Address - Fax:212-627-6926
Practice Address - Street 1:146 W 10TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3178
Practice Address - Country:US
Practice Address - Phone:212-255-4742
Practice Address - Fax:212-627-6926
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-051407-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYND4651Medicare ID - Type UnspecifiedMEDICARE PART-B