Provider Demographics
NPI:1245430669
Name:CAROLLO, DANIELA V
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:V
Last Name:CAROLLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 S VAN NESS AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2695
Mailing Address - Country:US
Mailing Address - Phone:415-850-8444
Mailing Address - Fax:
Practice Address - Street 1:459 FULTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4318
Practice Address - Country:US
Practice Address - Phone:415-562-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA26115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor