MEDICARE: VISTA THERAPY COLLECTIVE LICENSED CLINICAL SOCIAL WORKER PC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1730028911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA THERAPY COLLECTIVE LICENSED CLINICAL SOCIAL WORKER PC

Provider Business Mailing Address
First Line	:	2108 N ST # 8505
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5712
Country	:	US
Telephone Number	:	916-668-0575
Fax Number	:

Provider Business Practice Location Address
First Line	:	2108 N ST # 8505
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5712
Country	:	US
Telephone Number	:	916-668-0575
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH QUILL
Credential	:	LCSW
Telephone Number	:	916-668-0575

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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