Provider Demographics
NPI:1013189554
Name:NARVAEZ, AMANDA BALDIZAN (ICADC, CADC-II, QMHR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BALDIZAN
Last Name:NARVAEZ
Suffix:
Gender:F
Credentials:ICADC, CADC-II, QMHR
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RAE
Other - Last Name:BALDIZAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC-II, ICADC, QMHR
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:BRODERICK
Mailing Address - State:CA
Mailing Address - Zip Code:95605-0077
Mailing Address - Country:US
Mailing Address - Phone:916-607-4081
Mailing Address - Fax:
Practice Address - Street 1:137 N COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6646
Practice Address - Country:US
Practice Address - Phone:530-419-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X
CAA020470815101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)