Healthcare Provider Details

I. General information

NPI: 1891612750
Provider Name (Legal Business Name): DANIELLE M CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNNY CARLSON

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR APT 61B
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR
OXNARD CA
93036-0617
US

V. Phone/Fax

Practice location:
  • Phone: 866-998-2243
  • Fax:
Mailing address:
  • Phone: 866-998-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: