MEDICARE: DR. DANIEL CHARLES STALLONE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY61659694	WA
2	103T00000X	Psychologist	026098	NY
3	103TC0700X	Clinical Psychologist	PY61659694	WA
4	103TA0700X	Adult Development & Aging Psychologist	PY61659694	WA
5	103TA0700X	Adult Development & Aging Psychologist	026098	NY
6	103TC0700X	Clinical Psychologist	026098	NY

General Provider Information

NPI Number	:	1790557437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL CHARLES STALLONE PSY.D.

Provider Business Mailing Address
First Line	:	9600 VETERANS DR SW # A-116MHS
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98493-0003
Country	:	US
Telephone Number	:	253-582-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 VETERANS DR SW
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98493-0003
Country	:	US
Telephone Number	:	253-582-8440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2023
Last Update Date	:	12/13/2025

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