Basic Information
| Provider Information | |||||||||
| NPI: | 1982769212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEGOFF | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91-129 EWA BEACH RD | ||||||||
| Address2: | BUILDING A | ||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967062925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098282390 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 91-203 OLD FORT WEAVER RD | ||||||||
| Address2: | |||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086718511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 35SJ00409600 | NJ | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC2200X | PSY-596 | HI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.