Healthcare Provider Details

I. General information

NPI: 1558569822
Provider Name (Legal Business Name): LINA ELIZABETH DALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 BLUEBERRY DR
SCOTTS VALLEY CA
95066-4618
US

IV. Provider business mailing address

198 BLUEBERRY DR
SCOTTS VALLEY CA
95066-4618
US

V. Phone/Fax

Practice location:
  • Phone: 408-772-7017
  • Fax:
Mailing address:
  • Phone: 408-772-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW64292
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW64292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: