Healthcare Provider Details

I. General information

NPI: 1821376898
Provider Name (Legal Business Name): DANIELLE J HIBBITTS MS, MA, PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N SUTTER ST STE 400
STOCKTON CA
95202-2911
US

IV. Provider business mailing address

20 N SUTTER ST STE 400
STOCKTON CA
95202-2911
US

V. Phone/Fax

Practice location:
  • Phone: 510-872-8122
  • Fax:
Mailing address:
  • Phone: 510-872-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSB94022734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: