Healthcare Provider Details

I. General information

NPI: 1144504564
Provider Name (Legal Business Name): DWIGHT JEROME NORMAN JR. PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 17TH ST STE 101
BAKERSFIELD CA
93301-4251
US

IV. Provider business mailing address

8010 VIDIUS WAY
BAKERSFIELD CA
93313-6429
US

V. Phone/Fax

Practice location:
  • Phone: 661-348-4299
  • Fax: 661-215-1872
Mailing address:
  • Phone: 661-348-4299
  • Fax: 661-215-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31201
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: