Basic Information
| Provider Information | |||||||||
| NPI: | 1912658220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 500 JEFFERSON BLVD STE B195 | ||||||||
| Address2: | |||||||||
| City: | WEST SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956052350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164042970 | ||||||||
| FaxNumber: | 5302095255 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 JEFFERSON BLVD STE B195 | ||||||||
| Address2: | |||||||||
| City: | WEST SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956052350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164032970 | ||||||||
| FaxNumber: | 5302045255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2022 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 21227 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW21227 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.