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General NPI Number Information
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NPI Number | 1104399666
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Entity Type | Individual
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Provider Name | DANIEL MARTINSON PSYD
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Gender | Male
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 200 PROFESSIONAL PARK DR SE STE 4
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City | BLACKSBURG
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State | VA
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Zip | 24060-6663
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Country | US
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Telephone | 937-206-4993
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Fax |
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Provider Business Mailing Address
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Address Line | 200 PROFESSIONAL PARK DR SE STE 4
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City | BLACKSBURG
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State | VA
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Zip | 24060-6663
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Country | US
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Telephone | 937-206-4993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810006125
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License Number State | VA
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