Provider Demographics
NPI:1396391074
Name:CANEDA, DANIEL BRANDON (MSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRANDON
Last Name:CANEDA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 DEKALB INDUSTRIAL WAY STE D-1
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2230
Mailing Address - Country:US
Mailing Address - Phone:706-248-6389
Mailing Address - Fax:
Practice Address - Street 1:270 W OAK ST STE 2
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4813
Practice Address - Country:US
Practice Address - Phone:706-248-6389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
GAMSW0090671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health