Provider Demographics
NPI:1497085492
Name:VIDEC, DANIEL P (LSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:VIDEC
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S COURT ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2275
Mailing Address - Country:US
Mailing Address - Phone:330-723-7997
Mailing Address - Fax:330-725-5177
Practice Address - Street 1:230 S COURT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2275
Practice Address - Country:US
Practice Address - Phone:330-723-7997
Practice Address - Fax:330-725-5177
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0901029104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker