Provider Demographics
NPI:1487143558
Name:GAITA, DANIEL ROSSARIO (MA, LISW-CP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROSSARIO
Last Name:GAITA
Suffix:
Gender:M
Credentials:MA, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 CONANT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7178
Mailing Address - Country:US
Mailing Address - Phone:203-994-2987
Mailing Address - Fax:
Practice Address - Street 1:4016 CONANT RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7178
Practice Address - Country:US
Practice Address - Phone:203-994-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12302101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1490Medicaid