1811007719 NPI number — MS. WENDY ANDERSON RAB LCSW, MFCC

Table of content: MS. WENDY ANDERSON RAB LCSW, MFCC (NPI 1811007719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811007719 NPI number — MS. WENDY ANDERSON RAB LCSW, MFCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAB
Provider First Name:
WENDY
Provider Middle Name:
ANDERSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, MFCC
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:
1811007719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9264 MADISON AVE
Provider Second Line Business Mailing Address:
ROLLINGWOOD OFFICE PARK
Provider Business Mailing Address City Name:
ORANGEVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95662-5858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-988-2824
Provider Business Mailing Address Fax Number:
916-988-2824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9264 MADISON AVE
Provider Second Line Business Practice Location Address:
ROLLINGWOOD OFFICE PARK
Provider Business Practice Location Address City Name:
ORANGEVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95662-5858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-988-2824
Provider Business Practice Location Address Fax Number:
916-988-2824
Provider Enumeration Date:
08/30/2006

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: 101YM0800X , with the licence number:  LCS 16810 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: MFC30090 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 54220ZZZ54134Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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