Provider Demographics
NPI:1891896221
Name:MOSSMAN, DANIEL J (MA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:MOSSMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-0453
Mailing Address - Country:US
Mailing Address - Phone:351-218-1779
Mailing Address - Fax:
Practice Address - Street 1:7 BRANDYWINE LN
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2458
Practice Address - Country:US
Practice Address - Phone:351-218-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty