Provider Demographics
NPI:1912469404
Name:DUENAS, DANIEL A (LCSW, MAC,)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:DUENAS
Suffix:
Gender:M
Credentials:LCSW, MAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CHALAN SANTO PAPA REFLECTION CENTER STE101
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910
Mailing Address - Country:US
Mailing Address - Phone:671-686-3970
Mailing Address - Fax:
Practice Address - Street 1:222 CHALAN SANTO PAPA REFLECTION CENTER
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-686-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULCSW-E-0031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty