Provider Demographics
NPI:1124141031
Name:DAHL, DAVID FREDERICK (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FREDERICK
Last Name:DAHL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2542 S BASCOM AVE
Mailing Address - Street 2:STE 265
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5565
Mailing Address - Country:US
Mailing Address - Phone:408-793-0313
Mailing Address - Fax:408-371-9193
Practice Address - Street 1:2542 S BASCOM AVE
Practice Address - Street 2:STE 265
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-5565
Practice Address - Country:US
Practice Address - Phone:408-793-0313
Practice Address - Fax:408-796-7592
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19014103T00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X, 103TR0400X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation