Provider Demographics
NPI:1275778755
Name:MCCABE, DANIEL KELLY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KELLY
Last Name:MCCABE
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 1:1715 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-2238
Mailing Address - Country:US
Mailing Address - Phone:805-528-5635
Mailing Address - Fax:805-528-5635
Practice Address - Street 1:1715 11TH ST
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-2238
Practice Address - Country:US
Practice Address - Phone:805-528-5635
Practice Address - Fax:805-528-5635
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$AOtherMEDICARE NUMBER