Healthcare Provider Details

I. General information

NPI: 1346852720
Provider Name (Legal Business Name): NOELY PORCAYO-PAREDES ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NOELY PAREDES-AGUILERA

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 TESCONI CIR STE A
SANTA ROSA CA
95401-4691
US

IV. Provider business mailing address

1260 N DUTTON AVE STE 105
SANTA ROSA CA
95401-7121
US

V. Phone/Fax

Practice location:
  • Phone: 707-206-7268
  • Fax:
Mailing address:
  • Phone: 707-568-2300
  • Fax: 707-568-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: