Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | PSY000724 | GA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY000724 | GA |
N | 103TC1900X | Counseling Psychologist | PSY000724 | GA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY000724 | GA |
N | 103TF0200X | Forensic Psychologist | PSY000724 | GA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY000724 | GA |
NPI | 1194704031 |
---|---|
Provider Name | Dr. Daniel J. Kaeck |
First Address | Thomasville, GA 31799-1378 |
Second Address | Thomasville, GA 31792-7128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q47560 | (02) | GA |