Provider Demographics
NPI:1487997615
Name:MARANO, DAIDRA L (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAIDRA
Middle Name:L
Last Name:MARANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E SCHOOLHOUSE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1742
Mailing Address - Country:US
Mailing Address - Phone:630-881-1095
Mailing Address - Fax:
Practice Address - Street 1:102 E SCHOOLHOUSE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1742
Practice Address - Country:US
Practice Address - Phone:630-881-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-06
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008371103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic