Individual
DANIEL R MODEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY
Contact information
Practice address
1080 EMELINE AVE, SANTA CRUZ, CA 95060-1966
(831) 454-4100
Mailing address
1080 EMELINE AVE, SANTA CRUZ, CA 95060-1966
(831) 454-4100
(831) 454-4488
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 19315
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY 19315
LICENSE #
CA
Enumeration date
07/25/2006
Last updated
02/19/2025
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