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General NPI Number Information
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NPI Number | 1669344636
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Entity Type | Organization
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Legal Business Name | CALIFORNIA MAMMHA, A LICENSED CLINICAL SOCIAL WORKER PC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1248 HAYES ST
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City | NAPA
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State | CA
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Zip | 94559-1711
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Country | US
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Telephone | 831-920-7907
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Fax | 855-682-0606
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Provider Business Mailing Address
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Address Line | 3648 SAINT GAUDENS RD
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City | MIAMI
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State | FL
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Zip | 33133-6533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER SHULLY
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Credential | LCSW
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Telephone | 707-345-6565
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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 |
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License Number State |
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