Provider Demographics
NPI:1558079319
Name:CHUNG, DANIEL (MED, EDS, LPC-A)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MED, EDS, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 SHADY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2742
Mailing Address - Country:US
Mailing Address - Phone:847-627-0818
Mailing Address - Fax:
Practice Address - Street 1:1010 BRODHEAD ROAD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15108
Practice Address - Country:US
Practice Address - Phone:412-339-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89266101YM0800X
PAAPC000539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty