Provider Demographics
NPI:1144504564
Name:NORMAN, DWIGHT JEROME JR (PSYD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:JEROME
Last Name:NORMAN
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8010 VIDIUS WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-6429
Mailing Address - Country:US
Mailing Address - Phone:661-348-4299
Mailing Address - Fax:661-215-1872
Practice Address - Street 1:2026 17TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4251
Practice Address - Country:US
Practice Address - Phone:661-348-4299
Practice Address - Fax:661-215-1872
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA31201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst