Provider Demographics
NPI:1225625577
Name:KITCHEN, DANIELLE D
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:D
Last Name:KITCHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 N MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4624
Mailing Address - Country:US
Mailing Address - Phone:909-733-6507
Mailing Address - Fax:
Practice Address - Street 1:2900 ADAMS ST STE C170
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4349
Practice Address - Country:US
Practice Address - Phone:951-637-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician