MEDICARE: MRS. ADENE HERING FORDYCE ACSW

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	ASW 23948	CA

General Provider Information

NPI Number	:	1811102114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADENE HERING FORDYCE ACSW

Provider Business Mailing Address
First Line	:	3815 MARCONI AVE
Second Line	:	SUITE 1
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3867
Country	:	US
Telephone Number	:	916-485-4175
Fax Number	:	916-485-2673

Provider Business Practice Location Address
First Line	:	3815 MARCONI AVE
Second Line	:	SUITE 1
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3867
Country	:	US
Telephone Number	:	916-485-4175
Fax Number	:	916-485-2673

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/25/2012

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