Healthcare Provider Details

I. General information

NPI: 1770896706
Provider Name (Legal Business Name): TONNETTE D STUBBS-GOETHE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TONNETTE D STUBBS LCSW

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44750 60TH ST W
LANCASTER CA
93536-7619
US

IV. Provider business mailing address

PO BOX 2284
LANCASTER CA
93539-2284
US

V. Phone/Fax

Practice location:
  • Phone: 661-729-2000
  • Fax:
Mailing address:
  • Phone: 661-435-9961
  • Fax: 661-945-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS23670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: