Provider Demographics
NPI:1649463324
Name:MATTILA, DANIEL E (LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:E
Last Name:MATTILA
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 1:104 WALNUT TREE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1046
Mailing Address - Country:US
Mailing Address - Phone:203-426-9340
Mailing Address - Fax:
Practice Address - Street 1:36 W 44TH ST STE 1007
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8106
Practice Address - Country:US
Practice Address - Phone:212-221-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0556401041C0700X
CT0054951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical