Basic Information
| Provider Information | |||||||||
| NPI: | 1124189436 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 KALISA WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076523508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889486789 | ||||||||
| FaxNumber: | 8773453501 | ||||||||
| Practice Location | |||||||||
| Address1: | 26672 290TH STREET | ||||||||
| Address2: | |||||||||
| City: | BLENCOE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515234011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082952221 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 35SI00430100 | NJ | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 001150 | IA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.