Provider Demographics
NPI:1619237583
Name:GREG, DANIELLE LEE (PSYD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:GREG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:23801 CALABASAS RD STE 1003
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1554
Mailing Address - Country:US
Mailing Address - Phone:310-295-7190
Mailing Address - Fax:
Practice Address - Street 1:23801 CALABASAS RD STE 1003
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1554
Practice Address - Country:US
Practice Address - Phone:310-295-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical