Provider Demographics
NPI:1467521112
Name:DANZIG, PETER ANDREW (LCSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANDREW
Last Name:DANZIG
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 1:1610 W 500 N
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-2517
Mailing Address - Country:US
Mailing Address - Phone:801-865-9029
Mailing Address - Fax:
Practice Address - Street 1:1610 W 500 N
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-2517
Practice Address - Country:US
Practice Address - Phone:801-865-9029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5661960-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health