Provider Demographics
NPI:1699814913
Name:SOBREMONTE, PRISCILLA ANDREA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:ANDREA
Last Name:SOBREMONTE
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 1:950 W ZEERING RD APT 11
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-0213
Mailing Address - Country:US
Mailing Address - Phone:209-631-9981
Mailing Address - Fax:
Practice Address - Street 1:5637 N PERSHING AVE
Practice Address - Street 2:SUITE 11 B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4944
Practice Address - Country:US
Practice Address - Phone:209-631-9981
Practice Address - Fax:209-620-8387
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 223081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical