Provider Demographics
NPI:1629946421
Name:PICKERING, MARY LEE (ASW111655)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LEE
Last Name:PICKERING
Suffix:
Gender:F
Credentials:ASW111655
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 NOTRE DAME BLVD STE 370-102
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7161
Mailing Address - Country:US
Mailing Address - Phone:530-588-0448
Mailing Address - Fax:530-636-4888
Practice Address - Street 1:1074 EAST AVE STE A4
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1052
Practice Address - Country:US
Practice Address - Phone:530-588-0448
Practice Address - Fax:530-636-4888
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1116551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical