Provider Demographics
NPI:1154345049
Name:DANIELSON, NINA MAE (MSW)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:MAE
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 POPPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2027
Mailing Address - Country:US
Mailing Address - Phone:508-432-5152
Mailing Address - Fax:508-432-3861
Practice Address - Street 1:15 POPPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-2027
Practice Address - Country:US
Practice Address - Phone:508-432-5152
Practice Address - Fax:508-432-3861
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical