Provider Demographics
NPI:1831181601
Name:SOMBERG, DANIEL RICHARDS (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RICHARDS
Last Name:SOMBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 W 110TH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2302
Mailing Address - Country:US
Mailing Address - Phone:913-491-3460
Mailing Address - Fax:913-491-1141
Practice Address - Street 1:8400 W 110TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2302
Practice Address - Country:US
Practice Address - Phone:913-491-3460
Practice Address - Fax:913-491-1141
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS920103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0009197Medicare ID - Type UnspecifiedPROVIDERS NUMBERG