Provider Demographics
NPI:1265628119
Name:DALTON, E. JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:E.
Middle Name:JANE
Last Name:DALTON
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 1:760 PERINTON HILLS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3615
Mailing Address - Country:US
Mailing Address - Phone:585-223-5920
Mailing Address - Fax:585-223-5727
Practice Address - Street 1:760 PERINTON HILLS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3615
Practice Address - Country:US
Practice Address - Phone:585-223-5920
Practice Address - Fax:585-223-5727
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPENDING103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical