Provider Demographics
NPI:1174639421
Name:BORGMAN, CHRISTINA (MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BORGMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:BORGMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95668-0701
Mailing Address - Country:US
Mailing Address - Phone:916-655-3960
Mailing Address - Fax:
Practice Address - Street 1:5030 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4650
Practice Address - Country:US
Practice Address - Phone:916-609-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 17714104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker