Provider Demographics
NPI:1366858623
Name:PADILLA, SOCORRO ROCHA (LCSW-78088)
Entity Type:Individual
Prefix:
First Name:SOCORRO
Middle Name:ROCHA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:LCSW-78088
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 937
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95461-0937
Mailing Address - Country:US
Mailing Address - Phone:707-295-7249
Mailing Address - Fax:
Practice Address - Street 1:487 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5315
Practice Address - Country:US
Practice Address - Phone:707-263-4631
Practice Address - Fax:707-263-4650
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA780881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366858623Medicaid