Provider Demographics
NPI:1437203593
Name:MINERVA, DANIEL WARSAW (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WARSAW
Last Name:MINERVA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 STONE PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1607
Mailing Address - Country:US
Mailing Address - Phone:303-442-3110
Mailing Address - Fax:
Practice Address - Street 1:255 CANYON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4979
Practice Address - Country:US
Practice Address - Phone:303-442-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical