Healthcare Provider Details

I. General information

NPI: 1689128282
Provider Name (Legal Business Name): PATIENCE DAYTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date: 05/30/2018
Reactivation Date: 02/26/2021

III. Provider practice location address

3112 O ST STE 11
SACRAMENTO CA
95816-6579
US

IV. Provider business mailing address

PO BOX 246491
SACRAMENTO CA
95824-6491
US

V. Phone/Fax

Practice location:
  • Phone: 916-598-5648
  • Fax:
Mailing address:
  • Phone: 916-598-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98940
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: