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NPI Code Detail

MEDICARE: MRS. AMY HERREMA CHEVROLET LCSW

MEDICARE: MRS. AMY HERREMA CHEVROLET LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker20436CA
21041C0700XClinical Social WorkerLCS20436CA

General Provider Information

NPI Number : 1912040445
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY HERREMA CHEVROLET LCSW
Provider Business Mailing Address
First Line : 10340 WOODSIDE DR
Second Line :
City : FORESTVILLE
State : CA
Zip : 95436-9806
Country : US
Telephone Number : 707-308-9538
Fax Number :
Provider Business Practice Location Address
First Line : KEYSTONE THERAPY AND TRAINING SERVICES
Second Line : 4415 SONOMA HWY STE A
City : SANTA ROSA
State : CA
Zip : 95409-4165
Country : US
Telephone Number : 707-308-9538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2007
Last Update Date : 10/23/2023

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