Provider Demographics
NPI:1770595852
Name:GOLDWATER, ORNA DANIEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ORNA
Middle Name:DANIEL
Last Name:GOLDWATER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ORNA
Other - Middle Name:DANIEL
Other - Last Name:GOLDWATER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3000 CONNECTICUT AVE NW STE 137B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2549
Mailing Address - Country:US
Mailing Address - Phone:469-556-7128
Mailing Address - Fax:
Practice Address - Street 1:3000 CONNECTICUT AVE NW STE 137B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:469-556-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001392103TA0700X, 103TC1900X, 103TC2200X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N37RMedicare UPIN
TXCAN'T REMEMBERMedicare ID - Type UnspecifiedPLEASE FIND