Provider Demographics
NPI:1144031238
Name:CARRANZA, DANIEL ANDRES
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDRES
Last Name:CARRANZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 W 71ST PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-3544
Mailing Address - Country:US
Mailing Address - Phone:773-418-3866
Mailing Address - Fax:
Practice Address - Street 1:7851 185TH ST STE 203
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6503
Practice Address - Country:US
Practice Address - Phone:708-963-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0286201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical