=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629133160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. RICHARD A SHONINGER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 FREEDOM LN S
-----------------------------------------------------
City | PETALUMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94952-2164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-766-8571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 NEVIN AVE PSYCHIATRY DEPT
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94801-3143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-307-1624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS15306
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------