1699814913 NPI number — MS. PRISCILLA ANDREA SOBREMONTE LCSW

Table of content: MS. PRISCILLA ANDREA SOBREMONTE LCSW (NPI 1699814913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699814913 NPI number — MS. PRISCILLA ANDREA SOBREMONTE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOBREMONTE
Provider First Name:
PRISCILLA
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699814913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 W ZEERING RD APT 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TURLOCK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95382-0213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-631-9981
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5637 N PERSHING AVE
Provider Second Line Business Practice Location Address:
SUITE 11 B
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95207-4944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-631-9981
Provider Business Practice Location Address Fax Number:
209-620-8387
Provider Enumeration Date:
02/05/2007

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: 1041C0700X , with the licence number:  LCS 22308 , 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)





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