Provider Demographics
NPI:1356982524
Name:CHEATHAM, DANIEL PATRICK (LMSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PATRICK
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SEARLES RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-9751
Mailing Address - Country:US
Mailing Address - Phone:607-342-2782
Mailing Address - Fax:
Practice Address - Street 1:270 BOCES DR
Practice Address - Street 2:
Practice Address - City:SIDNEY CENTER
Practice Address - State:NY
Practice Address - Zip Code:13839-3105
Practice Address - Country:US
Practice Address - Phone:607-865-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107311101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool