Provider Demographics
NPI:1508960758
Name:CARPENTER, DANIEL D (PSYD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:D
Last Name:CARPENTER
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:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132
Mailing Address - Country:US
Mailing Address - Phone:503-538-4874
Mailing Address - Fax:503-538-1271
Practice Address - Street 1:501 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2909
Practice Address - Country:US
Practice Address - Phone:503-538-4874
Practice Address - Fax:503-538-1271
Is Sole Proprietor?:No
Enumeration Date:2006-09-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPSYCHOLOGIST1508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1508OtherPSYCHOLOGIST LICENSE NBR