1437666898 NPI number — ARLETTE ADELE LARGE LCSW , CADC III,

Table of content: ARLETTE ADELE LARGE LCSW , CADC III, (NPI 1437666898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437666898 NPI number — ARLETTE ADELE LARGE LCSW , CADC III,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARGE
Provider First Name:
ARLETTE
Provider Middle Name:
ADELE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW , CADC III,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LARGE
Provider Other First Name:
ARLETTE
Provider Other Middle Name:
ADELE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437666898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95501-3502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-498-4325
Provider Business Mailing Address Fax Number:
707-442-1191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 N ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95501-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-498-4325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  BII00070619 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 15356 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 121367 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 121367 . This is a "BOARD OF BEHAVIORAL HEALTH ( LICENSED CLINICAL SOCIAL WORKER)" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BII00070619 . This is a "CADCIII" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 015097 . This is a "NCAC I" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 15356 . This is a "BOARD OF LICENSED SOCIAL WORKERS LCSW" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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