Healthcare Provider Details

I. General information

NPI: 1417075904
Provider Name (Legal Business Name): ADRIENNE SHANETTE CHADWICK L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 LEMON ST
RIVERSIDE CA
92501-3844
US

IV. Provider business mailing address

29411 CALERA CT
MENIFEE CA
92584-7562
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-4545
  • Fax:
Mailing address:
  • Phone: 951-955-4545
  • 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:
Title or Position:
Credential:
Phone: