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General NPI Number Information
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NPI Number | 1528209954
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Entity Type | Individual
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Provider Name | DANIELLE RENE MIYASATO PHD
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Gender | Female
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 150 SHORELINE HWY BUILDING B, STE 22B
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City | MILL VALLEY
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State | CA
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Zip | 94941-3639
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Country | US
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Telephone | 415-408-7488
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Fax | 415-408-7488
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Provider Business Mailing Address
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Address Line | 357 DOLAN AVE
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City | MILL VALLEY
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State | CA
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Zip | 94941-3823
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Country | US
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Telephone | 619-251-3808
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Fax | 415-408-7488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY21712
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License Number State | CA
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