Healthcare Provider Details

I. General information

NPI: 1609739093
Provider Name (Legal Business Name): REGINA SEMOANE MATHIS ACSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 VIRGINIA ST
GRIDLEY CA
95948-2133
US

IV. Provider business mailing address

821 COLUSA AVE
OROVILLE CA
95965-4036
US

V. Phone/Fax

Practice location:
  • Phone: 530-846-4955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW128913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: