Provider Demographics
NPI:1245608801
Name:DANIELSON, ROBERT THOMAS (LMSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THOMAS
Last Name:DANIELSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 BALIN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 THOMPSON HAY PATH
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1317
Practice Address - Country:US
Practice Address - Phone:631-751-0197
Practice Address - Fax:631-751-0244
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2022-04-29
Deactivation Date:2020-04-15
Deactivation Code:
Reactivation Date:2020-07-14
Provider Licenses
StateLicense IDTaxonomies
NY104742-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker