Healthcare Provider Details

I. General information

NPI: 1457263378
Provider Name (Legal Business Name): OLD ADOBE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RAINIER CIR
PETALUMA CA
94954-2543
US

IV. Provider business mailing address

1900 RAINIER CIR
PETALUMA CA
94954-2543
US

V. Phone/Fax

Practice location:
  • Phone: 707-765-4305
  • Fax:
Mailing address:
  • Phone: 707-765-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: THOMAS GOLDBERG
Title or Position: SCHOOL COUNSELOR
Credential: PPS
Phone: 707-765-4305