Healthcare Provider Details

I. General information

NPI: 1821152299
Provider Name (Legal Business Name): ANGELA DAWN PRADO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA PRADO LCSW

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/28/2021
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 VICTOR AVE STE C
REDDING CA
96002-1454
US

IV. Provider business mailing address

2628 VICTOR AVE STE C
REDDING CA
96002-1454
US

V. Phone/Fax

Practice location:
  • Phone: 530-638-2355
  • Fax: 530-638-7269
Mailing address:
  • Phone: 530-638-2355
  • Fax: 530-638-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 70516
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW92162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: