Provider Demographics
NPI:1700292372
Name:IVAN F. DANGER PHD PA
Entity Type:Organization
Organization Name:IVAN F. DANGER PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:DANGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-854-9023
Mailing Address - Street 1:1801 SW 22ND ST STE 405
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2784
Mailing Address - Country:US
Mailing Address - Phone:305-854-9023
Mailing Address - Fax:305-854-9026
Practice Address - Street 1:1801 SW 22ND ST STE 405
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2784
Practice Address - Country:US
Practice Address - Phone:305-854-9023
Practice Address - Fax:305-854-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty