Basic Information
| Provider Information | |||||||||
| NPI: | 1992118046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | D'AMELIO | ||||||||
| FirstName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 229 | ||||||||
| Address2: | |||||||||
| City: | HOLDEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015200229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085567237 | ||||||||
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| Practice Location | |||||||||
| Address1: | 67 MILLBROOK ST STE 506 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085567237 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2014 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | 10284 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.