Provider Demographics
NPI:1881185759
Name:FANNING, DANIEL REXFORD (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:REXFORD
Last Name:FANNING
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SHADY COVE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-7126
Mailing Address - Country:US
Mailing Address - Phone:401-684-3144
Mailing Address - Fax:
Practice Address - Street 1:34 NARRAGANSETT AVE STE 3
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-1132
Practice Address - Country:US
Practice Address - Phone:401-846-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health