Healthcare Provider Details

I. General information

NPI: 1669652434
Provider Name (Legal Business Name): LYNN M. SCARBOROUGH ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 SHELBY PL
FAIRFIELD CA
94534-4312
US

IV. Provider business mailing address

3290 SHELBY PLACE
FAIRFIELD CA
94534
US

V. Phone/Fax

Practice location:
  • Phone: 707-553-5819
  • Fax: 707-553-5824
Mailing address:
  • Phone: 707-553-5819
  • Fax: 707-553-5824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 22646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: