Healthcare Provider Details

I. General information

NPI: 1356480792
Provider Name (Legal Business Name): RIVERSIDE COUNTY DEPT. OF MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 LEMON ST
RIVERSIDE CA
92501-3844
US

IV. Provider business mailing address

PO BOX 7823
RIVERSIDE CA
92513-7823
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4545
  • Fax:
Mailing address:
  • Phone: 951-787-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NANCI A. WISZNIA
Title or Position: CLINICAL THERAPIST
Credential: M.S.W.
Phone: 951-955-4545