=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851781967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBERLY DAINES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2015
-----------------------------------------------------
Last Update Date | 02/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9343 TECH CENTER DR STE 200
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95826-2592
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-388-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2757 ROYAL PARK DR
-----------------------------------------------------
City | CAMERON PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95682-9215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-800-5333
-----------------------------------------------------
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 | ASW64634
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------