Healthcare Provider Details

I. General information

NPI: 1073835633
Provider Name (Legal Business Name): EVANGELINE E FREATHY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9512 NICOLE LN
ELK GROVE CA
95758-3629
US

IV. Provider business mailing address

744 P ST
SACRAMENTO CA
95814-6400
US

V. Phone/Fax

Practice location:
  • Phone: 916-718-0794
  • Fax:
Mailing address:
  • Phone: 916-585-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: