Provider Demographics
NPI:1497223028
Name:DANEAU, DANIEL M (LIC PSY MA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:DANEAU
Suffix:
Gender:M
Credentials:LIC PSY MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3604
Mailing Address - Country:US
Mailing Address - Phone:802-809-1067
Mailing Address - Fax:802-540-1462
Practice Address - Street 1:12 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3604
Practice Address - Country:US
Practice Address - Phone:802-809-1067
Practice Address - Fax:802-540-1462
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0133669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical