Healthcare Provider Details

I. General information

NPI: 1851624241
Provider Name (Legal Business Name): JULIE RENAE AGUINIGA LCSW, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 MAIN ST
NEWMAN CA
95360-1119
US

IV. Provider business mailing address

890 MAIN ST
NEWMAN CA
95360-1119
US

V. Phone/Fax

Practice location:
  • Phone: 209-862-3670
  • Fax: 209-862-3426
Mailing address:
  • Phone: 209-862-3670
  • Fax: 209-862-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number31602
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75122
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: