Provider Demographics
NPI:1013570464
Name:UNDERWOOD, NADIA MIRIAM
Entity Type:Individual
Prefix:MS
First Name:NADIA
Middle Name:MIRIAM
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MORAGA RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4567
Mailing Address - Country:US
Mailing Address - Phone:510-689-2700
Mailing Address - Fax:
Practice Address - Street 1:901 MORAGA RD STE D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4567
Practice Address - Country:US
Practice Address - Phone:510-689-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA861891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86189OtherLCSW