Provider Demographics
NPI:1639343957
Name:DEREGO, SHARON A (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:DEREGO
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 1:2142 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2031
Mailing Address - Country:US
Mailing Address - Phone:530-746-8162
Mailing Address - Fax:530-298-9751
Practice Address - Street 1:719 2ND ST STE 3
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4666
Practice Address - Country:US
Practice Address - Phone:530-746-8162
Practice Address - Fax:530-298-9751
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical