MEDICARE: DR. DANIELLE TAYLOR PSYD

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	35SI00650800	NJ

General Provider Information

NPI Number	:	1841940301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE TAYLOR PSYD

Provider Business Mailing Address
First Line	:	PO BOX 273
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-0273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 PARK ST STE 1
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2988
Country	:	US
Telephone Number	:	917-464-5272
Fax Number	:

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

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	03/29/2022

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