Provider Demographics
NPI:1508238734
Name:MCDANIEL, ANDREW WESLEY (AA, NCCMP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WESLEY
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:AA, NCCMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 VILLAGE BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6914
Mailing Address - Country:US
Mailing Address - Phone:407-864-9312
Mailing Address - Fax:
Practice Address - Street 1:2701 VILLAGE BLVD
Practice Address - Street 2:APT 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6945
Practice Address - Country:US
Practice Address - Phone:407-864-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130309171M00000X
174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174V00000XOther Service ProvidersClinical Ethicist