Provider Demographics
NPI:1538488275
Name:GAYNOR, DANIEL TODD (LMHC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:TODD
Last Name:GAYNOR
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MAIN ST # 185
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2641
Mailing Address - Country:US
Mailing Address - Phone:518-268-9341
Mailing Address - Fax:
Practice Address - Street 1:228 MAIN ST # 185
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2641
Practice Address - Country:US
Practice Address - Phone:518-268-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC 110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0412OtherBC/BS PIN