MEDICARE: MR. JOSEPH ADAM NAAKE RADTI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	56298	CA

General Provider Information

NPI Number	:	1013455468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH ADAM NAAKE RADTI

Provider Business Mailing Address
First Line	:	256 BUENA VISTA ST
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-7239
Country	:	US
Telephone Number	:	530-274-2000
Fax Number	:	530-274-2116

Provider Business Practice Location Address
First Line	:	256 BUENA VISTA ST
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-7239
Country	:	US
Telephone Number	:	530-274-2000
Fax Number	:	530-274-2116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	02/06/2017

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