Healthcare Provider Details

I. General information

NPI: 1154779320
Provider Name (Legal Business Name): DANIEL WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2016
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

1562 TERRY LYNN LN
CONCORD CA
94521-3120
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-4789
  • Fax:
Mailing address:
  • Phone: 405-831-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: