Healthcare Provider Details

I. General information

NPI: 1235324021
Provider Name (Legal Business Name): BERTHA PICAZO RUVALCABA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERTHA PICAZO MSW, LCSW

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

IV. Provider business mailing address

2130 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-3662
  • Fax:
Mailing address:
  • Phone: 916-874-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: