MEDICARE: DR. KYLENE ANN HALLIDAY PSY. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY23575	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY23575	CA

General Provider Information

NPI Number	:	1366746026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLENE ANN HALLIDAY PSY. D.

Provider Business Mailing Address
First Line	:	1100 LINCOLN AVE
Second Line	:	364
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3056
Country	:	US
Telephone Number	:	408-915-7365
Fax Number	:	888-317-9483

Provider Business Practice Location Address
First Line	:	1100 LINCOLN AVE
Second Line	:	364
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3056
Country	:	US
Telephone Number	:	408-915-7365
Fax Number	:	888-317-9483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	11/04/2013

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