Provider Demographics
NPI:1457835761
Name:TAILLIEU, LUCY DANIELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:DANIELLE
Last Name:TAILLIEU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:TAILLIEU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2934 1/2 N BEVERLY GLEN CIR # 12
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16756 CHINO-CORONA ROAD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880
Practice Address - Country:US
Practice Address - Phone:909-597-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2023-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA33831103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program