Provider Demographics
NPI:1770600173
Name:MCCROSKEY, DANNY J
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:J
Last Name:MCCROSKEY
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 1:1784 SHAMROCK AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1868
Mailing Address - Country:US
Mailing Address - Phone:909-912-2548
Mailing Address - Fax:
Practice Address - Street 1:14700 MANZANITA PARK RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223
Practice Address - Country:US
Practice Address - Phone:951-845-3155
Practice Address - Fax:951-845-8412
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAMFC 53722106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7565AOtherOUTPATIENT MENTAL HELATH