| Fee For Service - Lcsw | |
|
800 Scenic Dr Modesto CA 95350-6131 | |
| (209) 558-4752 | |
| Not Available |
| Full Name | Fee For Service - Lcsw |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 800 Scenic Dr, Modesto, California |
| Authorized Official Name and Position | Ruben Imperial (BEHAVIORAL HEALTH INTERIM DIRECTOR) |
| Authorized Official Contact | 2095256225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fee For Service - Lcsw 800 Scenic Dr Modesto CA 95350-6131 Ph: () - | Fee For Service - Lcsw 800 Scenic Dr Modesto CA 95350-6131 Ph: (209) 558-4752 |
| NPI Number | 1174724884 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 10/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174724884 | NPI | - | NPPES |
| 5056 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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