Healthcare Provider Details

I. General information

NPI: 1225647761
Provider Name (Legal Business Name): DANIELLE BROOKE HARVEY ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 10TH ST
IMPERIAL BEACH CA
91932-2216
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2300
  • Fax: 619-296-0903
Mailing address:
  • Phone: 619-515-2300
  • Fax: 619-237-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number95454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: