Provider Demographics
NPI:1871611129
Name:CRANDALL, DANIEL H (MS)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:H
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SWAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6018
Mailing Address - Country:US
Mailing Address - Phone:386-689-4543
Mailing Address - Fax:866-463-9550
Practice Address - Street 1:2 SWAN AVE
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6018
Practice Address - Country:US
Practice Address - Phone:386-689-4543
Practice Address - Fax:866-463-9550
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health