Provider Demographics
NPI:1619907680
Name:OWEN, DANIEL H (LICSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:OWEN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5105
Mailing Address - Country:US
Mailing Address - Phone:781-626-0978
Mailing Address - Fax:781-592-1093
Practice Address - Street 1:150 MARKET ST FL 2
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1529
Practice Address - Country:US
Practice Address - Phone:781-592-6100
Practice Address - Fax:781-592-1093
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10218581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1858319Medicaid
MA1858319Medicaid