Provider Demographics
NPI:1821145582
Name:MACINTYRE, DANIEL I (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:I
Last Name:MACINTYRE
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 1:3700 VACA VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9430
Mailing Address - Country:US
Mailing Address - Phone:707-453-5598
Mailing Address - Fax:
Practice Address - Street 1:3700 VACA VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9430
Practice Address - Country:US
Practice Address - Phone:707-453-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19026103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent