Provider Demographics
NPI:1831330273
Name:WALTER, DANIEL DEAN (LADC,LSW-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:DEAN
Last Name:WALTER
Suffix:
Gender:M
Credentials:LADC,LSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OLD MILL ROAD
Mailing Address - Street 2:PO BOX 958
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0958
Mailing Address - Country:US
Mailing Address - Phone:207-667-3210
Mailing Address - Fax:207-667-3133
Practice Address - Street 1:8 OLD MILL ROAD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-0958
Practice Address - Country:US
Practice Address - Phone:207-667-3210
Practice Address - Fax:207-667-3133
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3874101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME22-2548836OtherMAINECARE