Healthcare Provider Details

I. General information

NPI: 1962372136
Provider Name (Legal Business Name): DANIEL ATKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 BLOOMFIELD AVE APT 3C
CALDWELL NJ
07006-5546
US

IV. Provider business mailing address

554 BLOOMFIELD AVE APT 3C
CALDWELL NJ
07006-5546
US

V. Phone/Fax

Practice location:
  • Phone: 908-309-7619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071.010612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: