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General NPI Number Information
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NPI Number | 1841649324
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Entity Type | Organization
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Legal Business Name | TRAVERSE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 2560 NORTHSIDE DR APT 203
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City | SAN DIEGO
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State | CA
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Zip | 92108-6759
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Country | US
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Telephone | 858-333-4353
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 NORTHSIDE DR APT 203
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City | SAN DIEGO
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State | CA
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Zip | 92108-6759
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. DANIELLE KRISTINA DELLNER
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Credential | PHD
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Telephone | 310-592-1125
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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 | PSY26318
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License Number State | CA
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