Provider Demographics
NPI:1851165815
Name:CAMINITI, DANIEL R
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:CAMINITI
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 1:4854 WILDLIFE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-4424
Mailing Address - Country:US
Mailing Address - Phone:262-321-8205
Mailing Address - Fax:
Practice Address - Street 1:647 W MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1993
Practice Address - Country:US
Practice Address - Phone:262-321-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7647-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional