=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386331569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL T ANGELL III PSY.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2023
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 GREENLEAF WOODS DR UNIT 301
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-407-6594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 IDA LN
-----------------------------------------------------
City | RAYMOND
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03077-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-490-9822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 1640
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------