Provider Demographics
NPI:1801280573
Name:DANIELS, YVONNE (LCSW)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:MARCHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:109 CALIFORNIA STREET
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-985-8221
Mailing Address - Fax:618-985-4635
Practice Address - Street 1:1006 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918
Practice Address - Country:US
Practice Address - Phone:618-985-4841
Practice Address - Fax:618-985-8101
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490174111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149017411OtherLICENSE
IL370966854004Medicaid
IL141816Medicare Oscar/Certification
IL640701Medicare PIN