Healthcare Provider Details

I. General information

NPI: 1497979926
Provider Name (Legal Business Name): ERIN B BASTIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29804 ROAD 210
EXETER CA
93221-9768
US

IV. Provider business mailing address

29804 ROAD 210
EXETER CA
93221-9768
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-4525
  • Fax:
Mailing address:
  • Phone: 559-592-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: