Healthcare Provider Details

I. General information

NPI: 1427089648
Provider Name (Legal Business Name): DANIEL EDWARD BOONE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 NORTHGATE BLVD
NEW ALBANY IN
47150-6419
US

IV. Provider business mailing address

811 NORTHGATE BLVD
NEW ALBANY IN
47150-6419
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-4628
  • Fax:
Mailing address:
  • Phone: 502-287-4628
  • Fax: 812-944-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042074A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: