Provider Demographics
NPI:1982769212
Name:LEGOFF, DANIEL B (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:LEGOFF
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 1:91-129 EWA BEACH RD
Mailing Address - Street 2:BUILDING A
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2925
Mailing Address - Country:US
Mailing Address - Phone:609-828-2390
Mailing Address - Fax:
Practice Address - Street 1:91-203 OLD FORT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-671-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SJ00409600103G00000X
HIPSY-596103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist