Healthcare Provider Details

I. General information

NPI: 1770765422
Provider Name (Legal Business Name): DANI E LITTLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N R ST
MADERA CA
93637-4465
US

IV. Provider business mailing address

177 LYON AVE
SANGER CA
93657
US

V. Phone/Fax

Practice location:
  • Phone: 559-661-5194
  • Fax:
Mailing address:
  • Phone: 559-906-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS23897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: