Provider Demographics
NPI:1184471088
Name:GENDELMAN, DANIEL (CADC-I)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:GENDELMAN
Suffix:
Gender:M
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 N NEVADA HIGHWAY 160 STE 600
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-5408
Mailing Address - Country:US
Mailing Address - Phone:775-505-1625
Mailing Address - Fax:775-403-1755
Practice Address - Street 1:2050 N NEVADA HIGHWAY 160 STE 600
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-5408
Practice Address - Country:US
Practice Address - Phone:775-505-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07720-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty