Healthcare Provider Details

I. General information

NPI: 1154515351
Provider Name (Legal Business Name): DANIEL JAMES RICHARDSON PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 DUQUESNE AVE
CULVER CITY CA
90232-2804
US

IV. Provider business mailing address

216 E IMPERIAL AVE APT 9
EL SEGUNDO CA
90245-2357
US

V. Phone/Fax

Practice location:
  • Phone: 310-253-6332
  • Fax:
Mailing address:
  • Phone: 310-308-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26856
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number26856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: