Provider Demographics
NPI:1164002457
Name:TSO, DANIEL REED
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:REED
Last Name:TSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S BINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:VT
Mailing Address - Zip Code:05753-9363
Mailing Address - Country:US
Mailing Address - Phone:315-254-9397
Mailing Address - Fax:
Practice Address - Street 1:51 S BINGHAM ST
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:VT
Practice Address - Zip Code:05753-9363
Practice Address - Country:US
Practice Address - Phone:315-254-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0135164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical