Provider Demographics
NPI:1568652394
Name:DANYLCHUK, PETER RICHARD (D MIN, MFT)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:RICHARD
Last Name:DANYLCHUK
Suffix:
Gender:M
Credentials:D MIN, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W 4TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1619
Mailing Address - Country:US
Mailing Address - Phone:650-572-2710
Mailing Address - Fax:650-349-3255
Practice Address - Street 1:4 W 4TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1619
Practice Address - Country:US
Practice Address - Phone:650-572-2710
Practice Address - Fax:650-349-3255
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT13842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist