Provider Demographics
NPI:1588316962
Name:CARRASQUILLO, DANIELLE M (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 38TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1909
Mailing Address - Country:US
Mailing Address - Phone:813-751-4603
Mailing Address - Fax:
Practice Address - Street 1:2361 38TH ST # 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1909
Practice Address - Country:US
Practice Address - Phone:813-751-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL154951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty