Active NPI
Charles Brady Dalton, PSY.D
- Clinical Psychologist
- Phoenix, AZ
National Provider Identifier
1073782884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3660
- Practice address
- 3118 E Maryland Ave
Phoenix, AZ 85016-2377 - Phone
- (602) 909-7539
- NPI assigned
- Feb 26, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3660 | AZ | Primary |
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 3660 | AZ | |
| Adult Development & Aging Psychologist | 103TA0700X | 3660 | AZ | |
| Psychologist | 103T00000X | 3660 | AZ |
Addresses
Primary practice location
3118 E Maryland Ave
Phoenix, AZ 85016-2377
Mailing address
3118 E Maryland Ave
Phoenix, AZ 85016-2377
Phone (602) 909-7539
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073782884 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3660 | AZ | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619654400000",
"number": "1073782884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3118 E MARYLAND AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850162377",
"telephone_number": "602-909-7539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3118 E MARYLAND AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850162377",
"telephone_number": "602-909-7539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALTON",
"first_name": "CHARLES",
"middle_name": "BRADY",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-26",
"last_updated": "2021-04-29",
"certification_date": "2021-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "3660",
"primary": true
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "AZ",
"license": "3660",
"primary": false
},
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "AZ",
"license": "3660",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "3660",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1073782884",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.