Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 5444 | OH |
N | 103T00000X | Psychologist | 5444 | OH |
N | 102L00000X | Psychologist | PS006635L | PA |
N | 103T00000X | Psychologist | PS006635L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS006635L | PA |
N | 103TA0700X | Adult Development & Aging Psychologist | PS006635L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS006635L | PA |
N | 103G00000X | Clinical Psychologist | PS006635L | PA |
N | 103TC0700X | Clinical Psychologist | PS006635L | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS006635L | PA |
N | 103TF0000X | Family Psychologist | PS006635L | PA |
N | 103TH0004X | Health Psychologist | PS006635L | PA |
N | 103TH0100X | Health Service | PS006635L | PA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PS006635L | PA |
NPI | 1568444602 |
---|---|
Provider Name | Dr. Daniel Materna |
First Address | Hermitage, PA 16148-3234 |
Second Address | Hermitage, PA 16148-3234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 08/07/2007 |