Healthcare Provider Details

I. General information

NPI: 1922174408
Provider Name (Legal Business Name): ROCIO BEATRIZ CUDDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 LINCOLN AVENUE SUITE 235
NAPA CA
94558-3631
US

IV. Provider business mailing address

595 LINCOLN AVENUE SUITE 235
NAPA CA
94558-3631
US

V. Phone/Fax

Practice location:
  • Phone: 707-259-4820
  • Fax:
Mailing address:
  • Phone: 707-259-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: