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General NPI Number Information
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NPI Number | 1962370411
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Entity Type | Individual
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Provider Name | DANIELLE EMILY PSILLOS PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 150 MONUMENT RD STE 207
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1725
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Country | US
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Telephone | 818-446-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 422 W JEFFERSON ST APT A
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City | MEDIA
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State | PA
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Zip | 19063-2658
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Country | US
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Telephone | 610-564-5133
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Fax |
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS020624
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License Number State | PA
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