Provider Demographics
NPI:1689681165
Name:ABBOTT, DANIEL J (LCSW, MFT)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAYOVAC DR.
Mailing Address - Street 2:#103
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2479
Mailing Address - Country:US
Mailing Address - Phone:608-238-5826
Mailing Address - Fax:608-238-1221
Practice Address - Street 1:700 RAYOVAC DR.
Practice Address - Street 2:#103
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2479
Practice Address - Country:US
Practice Address - Phone:608-238-5826
Practice Address - Fax:608-238-1221
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4-124106H00000X
WI3238-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689681165Medicaid
WI39665600Medicaid