MEDICARE: KELLEY CREDIFORD-PACHECO 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
1	104100000X	Social Worker	137717	CA

General Provider Information

NPI Number	:	1649780610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY CREDIFORD-PACHECO LCSW

Provider Business Mailing Address
First Line	:	4433 FLORIN RD STE 600
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2527
Country	:	US
Telephone Number	:	916-767-7458
Fax Number	:

Provider Business Practice Location Address
First Line	:	4433 FLORIN RD STE 600
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2527
Country	:	US
Telephone Number	:	916-767-7458
Fax Number	:

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

Provider Enumeration Date	:	10/04/2017
Last Update Date	:	04/13/2026

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