Healthcare Provider Details

I. General information

NPI: 1073162541
Provider Name (Legal Business Name): LUISA RENDON WARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2019
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ROWLAND WAY STE 220
NOVATO CA
94945-5039
US

IV. Provider business mailing address

PO BOX 683
PETALUMA CA
94953-0683
US

V. Phone/Fax

Practice location:
  • Phone: 628-336-5460
  • Fax: 707-559-7620
Mailing address:
  • Phone: 707-775-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: