Healthcare Provider Details

I. General information

NPI: 1225177355
Provider Name (Legal Business Name): JUANITA R SHOOPMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUANITA RODRIGUEZ SHOOPMAN LCSW

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MASON ST STE 201
VACAVILLE CA
95688-4535
US

IV. Provider business mailing address

419 MASON ST STE 201
VACAVILLE CA
95688-4535
US

V. Phone/Fax

Practice location:
  • Phone: 707-249-3405
  • Fax:
Mailing address:
  • Phone: 707-249-3405
  • Fax: 707-446-5397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17476
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS17476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: