Provider Demographics
NPI:1760604631
Name:NIERENBERG, DANI BARRETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANI
Middle Name:BARRETT
Last Name:NIERENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 NE 134TH ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3036
Mailing Address - Country:US
Mailing Address - Phone:360-450-0140
Mailing Address - Fax:877-343-0535
Practice Address - Street 1:2621 NE 134TH ST
Practice Address - Street 2:SUITE 340
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3036
Practice Address - Country:US
Practice Address - Phone:360-450-0140
Practice Address - Fax:877-343-0535
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1759103TB0200X, 103TC0700X, 103TH0004X
CAPSY15516103G00000X
WAPY60263831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist