Provider Demographics
NPI:1417627290
Name:PAVONE, DANIELLA CHERISE (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:CHERISE
Last Name:PAVONE
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491750
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-1750
Mailing Address - Country:US
Mailing Address - Phone:530-722-9957
Mailing Address - Fax:
Practice Address - Street 1:2135 PINE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2690
Practice Address - Country:US
Practice Address - Phone:530-276-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143032106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist