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General NPI Number Information
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NPI Number | 1275173833
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Entity Type | Organization
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Legal Business Name | DANIELLE DRAGON LLC
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Dates
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Enumeration Date | 01/12/2020
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Last Update Date | 01/12/2020
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Provider Practice Location Address
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Address Line | 518 DAVIS ST STE 217
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City | EVANSTON
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State | IL
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Zip | 60201-4624
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Country | US
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Telephone | 847-485-9060
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 W CHASE AVE
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City | CHICAGO
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State | IL
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Zip | 60645-1124
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Country | US
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Telephone | 847-485-9060
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DANIELLE DRAGON
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Credential | PSY.D.
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Telephone | 847-485-9060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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