Provider Demographics
NPI:1790881399
Name:GERSTENFIELD, DANIEL WELLIN (LCSW, BCD, MAC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WELLIN
Last Name:GERSTENFIELD
Suffix:
Gender:M
Credentials:LCSW, BCD, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-6752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1060 DAFFNEY ROAD
Practice Address - Street 2:DBH-BASSETT ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:907-361-6059
Practice Address - Fax:907-361-4861
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical