Provider Demographics
NPI:1003274622
Name:DANIEL, LIONEL (RBT)
Entity type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:DANIEL
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 E INDIAN SCHOOL RD STE 21-246
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5392
Mailing Address - Country:US
Mailing Address - Phone:480-335-7115
Mailing Address - Fax:
Practice Address - Street 1:4340 E INDIAN SCHOOL RD STE 21-246
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5392
Practice Address - Country:US
Practice Address - Phone:480-335-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician