Provider Demographics
NPI:1013078518
Name:HERMSEN, DANIEL E (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:HERMSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W231 N1440 CORPORATE COURT
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1303
Mailing Address - Country:US
Mailing Address - Phone:262-896-6186
Mailing Address - Fax:262-896-6139
Practice Address - Street 1:W231 N1440 CORPORATE COURT
Practice Address - Street 2:SUITE 310
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1301
Practice Address - Country:US
Practice Address - Phone:282-896-6186
Practice Address - Fax:262-896-6139
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11162101YA0400X
WI3457-1231041C0700X
WI34571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39385700Medicaid