Provider Demographics
NPI:1063043834
Name:LARSEN, DANIELLE JO (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JO
Last Name:LARSEN
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 1:900 SKOKIE BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4043
Mailing Address - Country:US
Mailing Address - Phone:847-668-4295
Mailing Address - Fax:
Practice Address - Street 1:900 SKOKIE BLVD STE 218
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4043
Practice Address - Country:US
Practice Address - Phone:847-668-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490211461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical