Provider Demographics
NPI:1700764701
Name:WILFRED, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WILFRED
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 1:604 ANNIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4809
Mailing Address - Country:US
Mailing Address - Phone:757-641-6995
Mailing Address - Fax:
Practice Address - Street 1:1700 SANSOM ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5234
Practice Address - Country:US
Practice Address - Phone:215-563-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00343-A101YM0800X
PAAPC001488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health