Healthcare Provider Details

I. General information

NPI: 1235617655
Provider Name (Legal Business Name): AUDREY LYNN RAMOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 05/17/2024
Certification Date: 05/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 N FRESNO ST STE 105
FRESNO CA
93720-2413
US

IV. Provider business mailing address

3835 N FREEWAY BLVD STE 100
SACRAMENTO CA
95834-1954
US

V. Phone/Fax

Practice location:
  • Phone: 855-427-2778
  • Fax: 559-225-1268
Mailing address:
  • Phone: 916-576-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: