Basic Information
| Provider Information | |||||||||
| NPI: | 1659456036 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIELOV | ||||||||
| FirstName: | MIKHAIL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10230 QUEENS BLVD | ||||||||
| Address2: | APT. #5J | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113753163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188967960 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9745 QUEENS BLVD | ||||||||
| Address2: | PH FLOOR | ||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113742101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188969090 | ||||||||
| FaxNumber: | 7188300724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 070871-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.