Healthcare Provider Details

I. General information

NPI: 1508960758
Provider Name (Legal Business Name): DANIEL D CARPENTER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 1ST ST
NEWBERG OR
97132-2909
US

IV. Provider business mailing address

PO BOX 636
NEWBERG OR
97132
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-4874
  • Fax: 503-538-1271
Mailing address:
  • Phone: 503-538-4874
  • Fax: 503-538-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYCHOLOGIST1508
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: