Provider Demographics
NPI:1710609193
Name:GOGA, DANIELLE K (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:K
Last Name:GOGA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-6294
Mailing Address - Country:US
Mailing Address - Phone:773-780-8811
Mailing Address - Fax:
Practice Address - Street 1:18350 CROSSING DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-6294
Practice Address - Country:US
Practice Address - Phone:773-780-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150109054104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker