Provider Demographics
NPI:1073162541
Name:WARD, LUISA RENDON (LCSW)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:RENDON
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94953-0683
Mailing Address - Country:US
Mailing Address - Phone:707-775-5670
Mailing Address - Fax:
Practice Address - Street 1:75 ROWLAND WAY STE 220
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5039
Practice Address - Country:US
Practice Address - Phone:628-336-5460
Practice Address - Fax:707-559-7620
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA845331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty