Provider Demographics
NPI:1891281267
Name:MOSNER, DANIEL (CAC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MOSNER
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LANTERN DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2724
Mailing Address - Country:US
Mailing Address - Phone:203-910-0614
Mailing Address - Fax:
Practice Address - Street 1:107 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1194
Practice Address - Country:US
Practice Address - Phone:203-910-0614
Practice Address - Fax:203-426-8947
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5296101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5295OtherCT CERTIFICATION BOARD