Provider Demographics
NPI:1053512954
Name:FOSTER, DANIEL R (MSW CSWA QMHP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MSW CSWA QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 IMPERIAL DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1697
Mailing Address - Country:US
Mailing Address - Phone:541-981-1606
Mailing Address - Fax:
Practice Address - Street 1:4760 PORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1760
Practice Address - Country:US
Practice Address - Phone:503-378-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
ORA132961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker