Provider Demographics
NPI:1427029008
Name:DAIGNAULT, JOHN HAROLD (PSYD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HAROLD
Last Name:DAIGNAULT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3943
Mailing Address - Country:US
Mailing Address - Phone:305-545-5244
Mailing Address - Fax:
Practice Address - Street 1:222 FORBES RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2706
Practice Address - Country:US
Practice Address - Phone:781-843-8100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3620103TF0200X
FLPY 6871103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic