Provider Demographics
NPI:1609114701
Name:LADONNA DAHL,PSY.D., INC.
Entity Type:Organization
Organization Name:LADONNA DAHL,PSY.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:786-512-9983
Mailing Address - Street 1:303 S BROADWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3173
Mailing Address - Country:US
Mailing Address - Phone:786-512-9983
Mailing Address - Fax:561-369-3275
Practice Address - Street 1:1101 N CONGRESS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3336
Practice Address - Country:US
Practice Address - Phone:786-512-9983
Practice Address - Fax:561-369-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8020103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY8020OtherMEDICAL LICENSE