Provider Demographics
NPI:1053375733
Name:DANIELS, CINDY (LCSW)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:SMALLIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8434
Mailing Address - Country:US
Mailing Address - Phone:207-883-0711
Mailing Address - Fax:207-883-2204
Practice Address - Street 1:200 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8434
Practice Address - Country:US
Practice Address - Phone:207-883-0711
Practice Address - Fax:207-883-2204
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC50111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM848001Medicare PIN
MEMM8480Medicare ID - Type Unspecified