Provider Demographics
NPI:1225162274
Name:DANIEL BLAESS, PH.D., PSYCHOLOGIST, INC.
Entity Type:Organization
Organization Name:DANIEL BLAESS, PH.D., PSYCHOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAESS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-804-1669
Mailing Address - Street 1:1350 COLUMBIA ST UNIT 402
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3455
Mailing Address - Country:US
Mailing Address - Phone:619-804-1669
Mailing Address - Fax:619-804-1669
Practice Address - Street 1:1350 COLUMBIA ST UNIT 402
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3455
Practice Address - Country:US
Practice Address - Phone:619-804-1669
Practice Address - Fax:619-804-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18777Medicare ID - Type Unspecified