Healthcare Provider Details

I. General information

NPI: 1982923322
Provider Name (Legal Business Name): DANIEL DEUTSCH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 SEAVIEW AVE
STATEN ISLAND NY
10305-2246
US

IV. Provider business mailing address

308 SEAVIEW AVE
STATEN ISLAND NY
10305-2246
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-1717
  • Fax: 718-667-8893
Mailing address:
  • Phone: 718-351-1717
  • Fax: 718-667-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number016395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: