Provider Demographics
NPI:1396724290
Name:FALLIN, DONALD NIALL (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:NIALL
Last Name:FALLIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W WINTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1216
Mailing Address - Country:US
Mailing Address - Phone:510-783-6899
Mailing Address - Fax:
Practice Address - Street 1:225 W WINTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1216
Practice Address - Country:US
Practice Address - Phone:510-783-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16419103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103T00000XBehavioral Health & Social Service ProvidersPsychologist