Provider Demographics
NPI:1649440827
Name:VAN INGEN, DANIEL J (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:VAN INGEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 OAK BAY DR
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-8960
Mailing Address - Country:US
Mailing Address - Phone:612-501-5358
Mailing Address - Fax:
Practice Address - Street 1:624 OAK BAY DR
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-8960
Practice Address - Country:US
Practice Address - Phone:612-501-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7918103T00000X
MNLP5058103T00000X
MI6301013662103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical