Provider Demographics
NPI:1063627891
Name:DALTON, JONATHAN (JONATHAN DALTON)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:DALTON
Suffix:
Gender:M
Credentials:JONATHAN DALTON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 VINTAGE SPRING TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1769
Mailing Address - Country:US
Mailing Address - Phone:301-260-0762
Mailing Address - Fax:
Practice Address - Street 1:11227 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4562
Practice Address - Country:US
Practice Address - Phone:301-593-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04388103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral