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General NPI Number Information
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NPI Number | 1558635540
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Entity Type | Individual
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Provider Name | KRISTIN QUAYLE L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 2221 STOCKTON BLVD CYPRESS BLDG, STE C
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City | SACRAMENTO
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State | CA
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Zip | 95817-1418
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Country | US
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Telephone | 916-734-5740
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Fax | 916-734-1339
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Provider Business Mailing Address
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Address Line | 4800 MODDISON AVE
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City | SACRAMENTO
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State | CA
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Zip | 95819-1500
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Country | US
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Telephone | 916-440-6655
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Fax |
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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 | 25852
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License Number State | CA
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