Provider Demographics
NPI:1568514966
Name:CID, GUADALUPE (MSW ASW 18886)
Entity Type:Individual
Prefix:MISS
First Name:GUADALUPE
Middle Name:
Last Name:CID
Suffix:
Gender:F
Credentials:MSW ASW 18886
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 188544
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-8544
Mailing Address - Country:US
Mailing Address - Phone:
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:916-609-4918
Practice Address - Fax:916-609-5160
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW18886104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker