Provider Demographics
NPI:1003073669
Name:CARLSON, DANIELLE S (MSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:S
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DAVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10702 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3310
Mailing Address - Country:US
Mailing Address - Phone:414-777-0740
Mailing Address - Fax:414-777-0749
Practice Address - Street 1:10702 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3310
Practice Address - Country:US
Practice Address - Phone:414-777-0740
Practice Address - Fax:414-777-0749
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7635-1231041C0700X
IL149.0126521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical