Provider Demographics
NPI:1821012675
Name:TEMPLE, DANIEL EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:TEMPLE
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 1:120 WEST PARK AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3301
Mailing Address - Country:US
Mailing Address - Phone:516-889-4552
Mailing Address - Fax:
Practice Address - Street 1:120 W PARK AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3301
Practice Address - Country:US
Practice Address - Phone:516-889-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012462103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
V09171Medicare PIN