Healthcare Provider Details

I. General information

NPI: 1497888531
Provider Name (Legal Business Name): DANA RENEE EDGULL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD ROOM 200
SALINAS CA
93906-3122
US

IV. Provider business mailing address

1270 NATIVIDAD RD
SALINAS CA
93906-3122
US

V. Phone/Fax

Practice location:
  • Phone: 831-784-2100
  • Fax:
Mailing address:
  • Phone: 831-784-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: