Healthcare Provider Details

I. General information

NPI: 1780763797
Provider Name (Legal Business Name): MARY CATHERINE PROFFITT-ALLISON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHY PROFFITT-ALLISON L.C.S.W.

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD SUITE 277
REDLANDS CA
92373-4775
US

IV. Provider business mailing address

101 E REDLANDS BLVD SUITE 277
REDLANDS CA
92373-4775
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-3026
  • Fax: 909-335-3167
Mailing address:
  • Phone: 909-335-3026
  • Fax: 909-335-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: