Healthcare Provider Details

I. General information

NPI: 1780758912
Provider Name (Legal Business Name): PAMELA DALENBERG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 N WALNUT ST SIEFERT COUNSELING CENTER
DANVILLE IL
61832-3965
US

IV. Provider business mailing address

6243 N 1800 EAST RD
GEORGETOWN IL
61846-6206
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-1400
  • Fax:
Mailing address:
  • Phone: 217-662-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: