Healthcare Provider Details

I. General information

NPI: 1023347176
Provider Name (Legal Business Name): DANIEL NORTHINGTON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 07/31/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC OKINAWA PSC 482
FPO AP
96362
US

IV. Provider business mailing address

NMRTC OKINAWA PSC 482
FPO AP
96362
US

V. Phone/Fax

Practice location:
  • Phone: 805-235-3425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: