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General NPI Number Information
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NPI Number | 1417067463
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Entity Type | Individual
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Provider Name | MAATISAK AMENHETEP GIPSON L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 6900 2ND STREET
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City | RIO LINDA
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State | CA
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Zip | 95673
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Country | US
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Telephone | 951-564-6715
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Fax | 916-457-2667
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Provider Business Mailing Address
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Address Line | 1200 GARAVENTA WAY
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City | SACRAMENTO
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State | CA
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Zip | 95833
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Country | US
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Telephone | 951-564-6715
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Fax | 916-457-2667
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS19290
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License Number State | CA
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