Provider Demographics
NPI:1972774933
Name:ELLENBERG, DANIEL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:ELLENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WINGED FOOT DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-5947
Mailing Address - Country:US
Mailing Address - Phone:415-883-5600
Mailing Address - Fax:415-883-5544
Practice Address - Street 1:2169 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4003
Practice Address - Country:US
Practice Address - Phone:415-515-0755
Practice Address - Fax:415-883-5544
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist