Basic Information
| Provider Information | |||||||||
| NPI: | 1720096340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2854 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344782854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527323333 | ||||||||
| FaxNumber: | 3527322469 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 E SILVER SPRINGS BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344706831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527323333 | ||||||||
| FaxNumber: | 3527322469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY0003688 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 75919 | 01 | FL | BCBS OF FLORIDA | OTHER |