Provider Demographics
NPI:1659456036
Name:DANIELOV, MIKHAIL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MIKHAIL
Middle Name:
Last Name:DANIELOV
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10230 QUEENS BLVD
Mailing Address - Street 2:APT. #5J
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3163
Mailing Address - Country:US
Mailing Address - Phone:718-896-7960
Mailing Address - Fax:
Practice Address - Street 1:9745 QUEENS BLVD
Practice Address - Street 2:PH FLOOR
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2101
Practice Address - Country:US
Practice Address - Phone:718-896-9090
Practice Address - Fax:718-830-0724
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070871-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical