Provider Demographics
NPI:1548640618
Name:SERPICO, DANIEL (LCSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SERPICO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STARBOARD ST
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-2958
Mailing Address - Country:US
Mailing Address - Phone:732-773-8832
Mailing Address - Fax:
Practice Address - Street 1:509 MAIN ST
Practice Address - Street 2:BLDG C
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7402
Practice Address - Country:US
Practice Address - Phone:732-773-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058091001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty