Healthcare Provider Details

I. General information

NPI: 1760368781
Provider Name (Legal Business Name): DANIELLE MESSINA CAPONE M.A. , P.P.S
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 SAN MIGUEL AVE
SANTA ROSA CA
95403-1986
US

IV. Provider business mailing address

3450 COFFEY LN
SANTA ROSA CA
95403-1919
US

V. Phone/Fax

Practice location:
  • Phone: 707-522-3015
  • Fax:
Mailing address:
  • Phone: 707-522-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: