Provider Demographics
NPI:1225177355
Name:SHOOPMAN, JUANITA R (LCSW)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:R
Last Name:SHOOPMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:RODRIGUEZ
Other - Last Name:SHOOPMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:419 MASON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4535
Mailing Address - Country:US
Mailing Address - Phone:707-249-3405
Mailing Address - Fax:707-446-5397
Practice Address - Street 1:419 MASON ST STE 201
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4535
Practice Address - Country:US
Practice Address - Phone:707-249-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS174761041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical