Healthcare Provider Details

I. General information

NPI: 1366581456
Provider Name (Legal Business Name): DANIELLE LYNN HALL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE LYNN EVILSIZER PSYD

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 01/11/2022
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 JUNIPERO SERRA BLVD
DALY CITY CA
94014-3891
US

IV. Provider business mailing address

2001 JUNIPERO SERRA BLVD
DALY CITY CA
94014-3891
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: