Provider Demographics
NPI:1962370411
Name:PSILLOS, DANIELLE EMILY (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:EMILY
Last Name:PSILLOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 W JEFFERSON ST APT A
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2658
Mailing Address - Country:US
Mailing Address - Phone:610-564-5133
Mailing Address - Fax:
Practice Address - Street 1:150 MONUMENT RD STE 207
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1725
Practice Address - Country:US
Practice Address - Phone:818-446-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020624103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent