Healthcare Provider Details

I. General information

NPI: 1437484946
Provider Name (Legal Business Name): DANIELLE NICHOLE BOORE MS CAS NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE BOORE

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

IV. Provider business mailing address

15399 W EUGENE TER
SURPRISE AZ
85379-8136
US

V. Phone/Fax

Practice location:
  • Phone: 623-523-8119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4190879
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: