Provider Demographics
NPI:1942762299
Name:DR. DANESSA MAYO, PHD
Entity Type:Organization
Organization Name:DR. DANESSA MAYO, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-882-1498
Mailing Address - Street 1:1190 LINCOLN AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3036
Mailing Address - Country:US
Mailing Address - Phone:408-882-1498
Mailing Address - Fax:408-504-1435
Practice Address - Street 1:1190 LINCOLN AVE STE 7
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3036
Practice Address - Country:US
Practice Address - Phone:408-882-1498
Practice Address - Fax:408-504-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty