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General NPI Number Information
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NPI Number | 1649690298
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Entity Type | Individual
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Provider Name | MICHAEL RACADIO
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 1020 CORONADO DR
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City | REDLANDS
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State | CA
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Zip | 92374-6293
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Country | US
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Telephone | 909-300-2516
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7340
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City | REDLANDS
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State | CA
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Zip | 92375-0340
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Country | US
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Telephone | 909-300-2516
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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 | LCSW75339
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License Number State | CA
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