Provider Demographics
NPI:1538664719
Name:DICARLO-PAMPERIN, DANIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DICARLO-PAMPERIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DICARLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9003 POLIFKA RD
Mailing Address - Street 2:
Mailing Address - City:WHITELAW
Mailing Address - State:WI
Mailing Address - Zip Code:54247-9782
Mailing Address - Country:US
Mailing Address - Phone:920-403-0021
Mailing Address - Fax:
Practice Address - Street 1:9003 POLIFKA RD
Practice Address - Street 2:
Practice Address - City:WHITELAW
Practice Address - State:WI
Practice Address - Zip Code:54247-9782
Practice Address - Country:US
Practice Address - Phone:920-403-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical