Basic Information
| Provider Information | |||||||||
| NPI: | 1619074887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAISER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | WALTER | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 VAUGHAN ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076622221 | ||||||||
| FaxNumber: | 2076626816 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 VAUGHAN ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076622221 | ||||||||
| FaxNumber: | 2076626816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 03/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC6792 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.