Provider Demographics
NPI:1295824860
Name:KIRSCHENBAUM, DANIEL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:KIRSCHENBAUM
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 1:1665 HIGHWAY 34 E
Mailing Address - Street 2:STE 100
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2404
Mailing Address - Country:US
Mailing Address - Phone:770-514-6760
Mailing Address - Fax:
Practice Address - Street 1:1665 HIGHWAY 34 E
Practice Address - Street 2:STE 100
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2404
Practice Address - Country:US
Practice Address - Phone:770-514-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003655103TB0200X
IL072-003557103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364870Medicare ID - Type Unspecified
IL162-0249OtherBLUE CROSS/BLUE SHIELD