Provider Demographics
NPI:1922017680
Name:LOTT, DANIEL RALPH (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RALPH
Last Name:LOTT
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 1:211 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559
Mailing Address - Country:US
Mailing Address - Phone:707-758-7549
Mailing Address - Fax:
Practice Address - Street 1:211 LAKEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559
Practice Address - Country:US
Practice Address - Phone:707-758-7549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL44910Medicare ID - Type Unspecified