Provider Demographics
NPI:1366746026
Name:HALLIDAY, KYLENE ANN (PSY D)
Entity type:Individual
Prefix:DR
First Name:KYLENE
Middle Name:ANN
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LINCOLN AVE
Mailing Address - Street 2:364
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3056
Mailing Address - Country:US
Mailing Address - Phone:408-915-7365
Mailing Address - Fax:888-317-9483
Practice Address - Street 1:1100 LINCOLN AVE
Practice Address - Street 2:364
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3056
Practice Address - Country:US
Practice Address - Phone:408-915-7365
Practice Address - Fax:888-317-9483
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23575103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent