Provider Demographics
NPI:1659883239
Name:PAULSON, DANIEL LEE (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:PAULSON
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 1:341 N MAITLAND AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4761
Mailing Address - Country:US
Mailing Address - Phone:407-756-2084
Mailing Address - Fax:866-495-9224
Practice Address - Street 1:1254 GRANTHAM CT
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5807
Practice Address - Country:US
Practice Address - Phone:540-746-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical