1124268362 NPI number — MS. DANIELLE FRANCINE BRESLOW DODSON LCSW

Table of content: MS. DANIELLE FRANCINE BRESLOW DODSON LCSW (NPI 1124268362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124268362 NPI number — MS. DANIELLE FRANCINE BRESLOW DODSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODSON
Provider First Name:
DANIELLE
Provider Middle Name:
FRANCINE BRESLOW
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRESLOW
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
FRANCINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124268362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1875 DEMPSTER ST
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
PARK RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60068-1186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-720-6464
Provider Business Mailing Address Fax Number:
847-720-6463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1875 DEMPSTER ST
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068-1186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-720-6464
Provider Business Practice Location Address Fax Number:
847-720-6463
Provider Enumeration Date:
02/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.013316 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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