Provider Demographics
NPI:1821125212
Name:SCHIEVELLA, DANIEL F (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:F
Last Name:SCHIEVELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2013
Mailing Address - Country:US
Mailing Address - Phone:201-871-2118
Mailing Address - Fax:201-947-4026
Practice Address - Street 1:10 W IVY LN
Practice Address - Street 2:SUITE #7
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-6705
Practice Address - Country:US
Practice Address - Phone:201-871-2118
Practice Address - Fax:201-947-4026
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100220000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0766607Medicaid
NJ593514Medicare ID - Type Unspecified