Provider Demographics
NPI:1750675492
Name:ADAM, DANE (MSW)
Entity Type:Individual
Prefix:MR
First Name:DANE
Middle Name:
Last Name:ADAM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2406
Mailing Address - Country:US
Mailing Address - Phone:619-512-3263
Mailing Address - Fax:
Practice Address - Street 1:4720 WILSON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2406
Practice Address - Country:US
Practice Address - Phone:619-512-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical