Provider Demographics
NPI:1922082692
Name:DOLGIN, DANIEL L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:DOLGIN
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 1:2898 PANAMA CIR
Mailing Address - Street 2:
Mailing Address - City:LILLIAN
Mailing Address - State:AL
Mailing Address - Zip Code:36549-5231
Mailing Address - Country:US
Mailing Address - Phone:850-516-2102
Mailing Address - Fax:850-607-9039
Practice Address - Street 1:1900 SUMMIT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-682-1903
Practice Address - Fax:850-436-5959
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5033103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686188100Medicaid