Provider Demographics
NPI:1619979499
Name:DANIELL, DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:DANIELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N FENNIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8393
Mailing Address - Country:US
Mailing Address - Phone:520-780-7687
Mailing Address - Fax:
Practice Address - Street 1:800 N SWAN RD
Practice Address - Street 2:STE 122
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1275
Practice Address - Country:US
Practice Address - Phone:520-780-7687
Practice Address - Fax:866-827-3910
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 118021041C0700X
KSLSCSW 22421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical