Provider Demographics
NPI:1386998524
Name:DALTON, EMILY (MA)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 1/2 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-3322
Mailing Address - Country:US
Mailing Address - Phone:323-383-7648
Mailing Address - Fax:
Practice Address - Street 1:41 E FOOTHILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2361
Practice Address - Country:US
Practice Address - Phone:626-701-4249
Practice Address - Fax:626-737-6034
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
CA30976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30976OtherBOARD OF PSYCHOLOGY
CA01261511Medicaid