Doctor Name: | CAROLINE VIDAL |
NPI Number: | 1013277292 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | LMSW-13018 |
Business Practice Address: | 290 E. Gobbi St. Ukiah, CA - 95482 |
Business Phone Number: | 7074633300 |
Business Fax Number: | |
Mailing Address: | Po Box 32, CLEARLAKE OAKS |
State: | CA |
Postal Code: | 95432 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/22/2012 |
NPI Last Update Date: | 05/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LMSW-13018 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |