Healthcare Provider Details

I. General information

NPI: 1336212661
Provider Name (Legal Business Name): DANAE GANOS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DANAE STRAIN

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 02/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 STONEGATE RD UNIT K
ALGONQUIN IL
60102-5614
US

IV. Provider business mailing address

4314 MARKET ST
CRYSTAL LAKE IL
60012-2810
US

V. Phone/Fax

Practice location:
  • Phone: 847-791-5514
  • Fax: 815-356-6445
Mailing address:
  • Phone: 847-679-1551
  • Fax: 815-356-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149005037
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: