Provider Demographics
NPI:1356471015
Name:DANIEL, CAROLYN WANDER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:WANDER
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4212
Mailing Address - Country:US
Mailing Address - Phone:925-960-0863
Mailing Address - Fax:925-373-0453
Practice Address - Street 1:1430 2ND ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4212
Practice Address - Country:US
Practice Address - Phone:925-960-0863
Practice Address - Fax:925-373-0453
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS85231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical