Provider Demographics
NPI:1831640572
Name:BROWN, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BROWN
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 1:279 E ARROW HWY
Mailing Address - Street 2:102
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3319
Mailing Address - Country:US
Mailing Address - Phone:909-623-6651
Mailing Address - Fax:909-623-0455
Practice Address - Street 1:6267 VARIEL AVE
Practice Address - Street 2:STE B
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2512
Practice Address - Country:US
Practice Address - Phone:818-651-0411
Practice Address - Fax:818-657-0406
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94302106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist