Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003219734 |
---|---|
Provider Name | Rechelle Naylor |
First Address | San Leandro, CA 94578-1132 |
Second Address | San Pablo, CA 94806-3305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2014 |
Last Update Date | 31/12/2019 |