Provider Demographics
NPI:1659347680
Name:STASI, DANIEL E
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:E
Last Name:STASI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-0706
Mailing Address - Country:US
Mailing Address - Phone:815-787-0515
Mailing Address - Fax:815-787-0505
Practice Address - Street 1:304 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3735
Practice Address - Country:US
Practice Address - Phone:815-787-0515
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-1234567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional