Provider Demographics
NPI:1568807709
Name:WELLS, RAQUEL C (LCSW)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:C
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 SHATTUCK AVE STE 302
Mailing Address - Street 2:UNIT 304
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1872
Mailing Address - Country:US
Mailing Address - Phone:510-426-5959
Mailing Address - Fax:
Practice Address - Street 1:2991 SHATTUCK AVE STE 302
Practice Address - Street 2:UNIT 304
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1872
Practice Address - Country:US
Practice Address - Phone:510-426-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool