Provider Demographics
NPI:1942242896
Name:DANIEL, STEPHEN ALLEN (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALLEN
Last Name:DANIEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 130926
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0926
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:193 CLINTON AVENUE
Practice Address - Street 2:CORTLAND CARE NURSING CENTER
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1420
Practice Address - Country:US
Practice Address - Phone:607-756-9921
Practice Address - Fax:607-756-8954
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8545103TC0700X
NY008545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00233713OtherRAILROAD
NY01008997Medicaid
NYA400018770Medicare PIN
NYP00233713OtherRAILROAD
NYV29241Medicare ID - Type Unspecified
NY01008997Medicaid
NYV29243T291Medicare PIN
NYR52419Medicare UPIN