Provider Demographics
NPI:1255657029
Name:BERARDUCCI, DANIEL ALLEN (CPC, ACS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALLEN
Last Name:BERARDUCCI
Suffix:
Gender:M
Credentials:CPC, ACS
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 35586
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5586
Mailing Address - Country:US
Mailing Address - Phone:702-518-4532
Mailing Address - Fax:
Practice Address - Street 1:7041 SUNHAMPTON AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-1735
Practice Address - Country:US
Practice Address - Phone:702-518-4532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health