Provider Demographics
NPI:1689098147
Name:BERTAGNA, STACI (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:BERTAGNA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 COURT ST STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1650
Mailing Address - Country:US
Mailing Address - Phone:530-338-1452
Mailing Address - Fax:
Practice Address - Street 1:1388 COURT ST STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1650
Practice Address - Country:US
Practice Address - Phone:530-338-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 369411041C0700X
CALCSW640841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical