Healthcare Provider Details

I. General information

NPI: 1245960624
Provider Name (Legal Business Name): DANIELLE ANITA KRAMER RADT1, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W CREST ST STE 100
ESCONDIDO CA
92025-1735
US

IV. Provider business mailing address

221 W CREST ST STE 100
ESCONDIDO CA
92025-1735
US

V. Phone/Fax

Practice location:
  • Phone: 760-744-3672
  • Fax:
Mailing address:
  • Phone: 760-744-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: