Provider Demographics
NPI:1073591178
Name:DAY, DENNIS A (PHD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:DAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4831 N. E. 26TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4816
Mailing Address - Country:US
Mailing Address - Phone:954-776-7992
Mailing Address - Fax:954-776-6850
Practice Address - Street 1:6245 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 423
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1998
Practice Address - Country:US
Practice Address - Phone:954-776-7992
Practice Address - Fax:954-776-6850
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2139103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112053100Medicaid
FL111110 00E87Medicaid