Provider Demographics
NPI:1235160243
Name:FEENEY, MARY PAT SR (LCSW RN)
Entity Type:Individual
Prefix:
First Name:MARY PAT
Middle Name:
Last Name:FEENEY
Suffix:SR
Gender:F
Credentials:LCSW RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11583 C AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2703
Mailing Address - Country:US
Mailing Address - Phone:530-823-1629
Mailing Address - Fax:530-885-7714
Practice Address - Street 1:853 LINCOLN WAY STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4832
Practice Address - Country:US
Practice Address - Phone:530-823-1629
Practice Address - Fax:530-885-7714
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS18352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA159791OtherCOM PSTCH
CA222015OtherMHN
CA3983OtherCONCERN EAP
CA6236927OtherUSBH
CACWS183520Medicaid
CA159791OtherCOM PSTCH
CA6236927OtherUSBH