Provider Demographics
NPI:1891076667
Name:DANIELS, CHARLES C
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:C
Last Name:DANIELS
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 1:100A WARREN ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3209
Mailing Address - Country:US
Mailing Address - Phone:617-708-0870
Mailing Address - Fax:
Practice Address - Street 1:100A WARREN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-3209
Practice Address - Country:US
Practice Address - Phone:617-708-0870
Practice Address - Fax:617-516-8274
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X
MA1197021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator