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NPI Code Detail

MEDICARE: REGINA NICOLE CANTRELL-KINZFOGL LCSW

MEDICARE: REGINA NICOLE CANTRELL-KINZFOGL LCSW
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
1104100000XSocial Worker
21041C0700XClinical Social Worker80514CA

General Provider Information

NPI Number : 1598159154
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINA NICOLE CANTRELL-KINZFOGL LCSW
Provider Business Mailing Address
First Line : 3800 COOLIDGE AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94602-3399
Country : US
Telephone Number : 510-846-9966
Fax Number : 510-485-5351
Provider Business Practice Location Address
First Line : 3800 COOLIDGE AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94602-3399
Country : US
Telephone Number : 510-846-9966
Fax Number : 510-485-5351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2015
Last Update Date : 04/02/2018

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