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General NPI Number Information
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NPI Number | 1902755325
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Entity Type | Organization
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Legal Business Name | EVERGREEN PSYCHOLOGY NEW YORK P.C.
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 513 N GOWER ST
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City | LOS ANGELES
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State | CA
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Zip | 90004-1301
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Country | US
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Telephone | 206-801-1621
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Fax | 206-260-3185
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Provider Business Mailing Address
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Address Line | 1201 2ND AVE STE 900
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City | SEATTLE
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State | WA
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Zip | 98101-3020
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Country | US
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Telephone | 206-801-1621
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Fax | 206-260-3185
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Authorized Official
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Title or Position | HEAD OF NEUROPSYCHOLOGICAL SERVICES
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Name | DR. DANIEL FENTON
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Credential | PHD
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Telephone | 425-270-7631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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