Provider Demographics
NPI:1104664416
Name:CARRANZA, DANIELLE JEAN
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JEAN
Last Name:CARRANZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:JEAN
Other - Last Name:CANTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7851 185TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6503
Mailing Address - Country:US
Mailing Address - Phone:773-391-0555
Mailing Address - Fax:
Practice Address - Street 1:7851 185TH ST STE 203
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6503
Practice Address - Country:US
Practice Address - Phone:773-391-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0273481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical