Provider Demographics
NPI:1376767202
Name:DANIS, BARBARA (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DANIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4256 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1110
Mailing Address - Country:US
Mailing Address - Phone:773-251-5178
Mailing Address - Fax:
Practice Address - Street 1:4256 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1110
Practice Address - Country:US
Practice Address - Phone:773-251-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006252103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK20504Medicare ID - Type UnspecifiedMEMBER ID