Healthcare Provider Details

I. General information

NPI: 1174924435
Provider Name (Legal Business Name): ANDREA L STOCKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 10/25/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S GREEN ST
TEHACHAPI CA
93561-1717
US

IV. Provider business mailing address

PO BOX 2390
TEHACHAPI CA
93581-2390
US

V. Phone/Fax

Practice location:
  • Phone: 760-428-2776
  • Fax:
Mailing address:
  • Phone: 760-428-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: