Provider Demographics
NPI:1790118321
Name:MCDANIEL, ERIC H
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:MCDANIEL
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 1:60 S STOCKWELL RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0247
Mailing Address - Country:US
Mailing Address - Phone:812-475-5437
Mailing Address - Fax:812-422-7558
Practice Address - Street 1:415 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1230
Practice Address - Country:US
Practice Address - Phone:812-423-7791
Practice Address - Fax:812-422-7558
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33006420A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker