Provider Demographics
NPI:1407052384
Name:JACE, DANIEL ARTHUR (BS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ARTHUR
Last Name:JACE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2623
Mailing Address - Country:US
Mailing Address - Phone:860-394-9968
Mailing Address - Fax:
Practice Address - Street 1:91 NORTHWEST DRIVE
Practice Address - Street 2:
Practice Address - City:PLANVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062
Practice Address - Country:US
Practice Address - Phone:860-394-9968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health