Provider Demographics
NPI:1558327239
Name:NOLL, DANIEL ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ADAM
Last Name:NOLL
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 1:16 SAND PIPER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-3426
Mailing Address - Country:US
Mailing Address - Phone:732-306-9609
Mailing Address - Fax:
Practice Address - Street 1:16 SAND PIPER DR
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-3426
Practice Address - Country:US
Practice Address - Phone:732-306-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5410103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ389026Medicare PIN
MAW50718Medicare PIN