Provider Demographics
NPI:1760098271
Name:MORTIMER, DANIELLE (PSY D)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 KNIGHTSBRIDGE RD APT 2313
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1208
Mailing Address - Country:US
Mailing Address - Phone:813-203-6100
Mailing Address - Fax:
Practice Address - Street 1:1340 PRUDENTIAL DR STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-4115
Practice Address - Country:US
Practice Address - Phone:214-631-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program