Healthcare Provider Details

I. General information

NPI: 1942221130
Provider Name (Legal Business Name): RAYNA BERTOLUCCI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 WEST ST 2ND FLOOR
REDDING CA
96001-1725
US

IV. Provider business mailing address

2205 HILLTOP DR STE 15
REDDING CA
96002-0511
US

V. Phone/Fax

Practice location:
  • Phone: 530-949-0420
  • Fax: 530-365-6752
Mailing address:
  • Phone: 530-221-2585
  • Fax: 530-221-2585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: