Provider Demographics
NPI:1811007719
Name:RAB, WENDY ANDERSON (LCSW, MFCC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANDERSON
Last Name:RAB
Suffix:
Gender:F
Credentials:LCSW, MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9264 MADISON AVE
Mailing Address - Street 2:ROLLINGWOOD OFFICE PARK
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-5858
Mailing Address - Country:US
Mailing Address - Phone:916-988-2824
Mailing Address - Fax:916-988-2824
Practice Address - Street 1:9264 MADISON AVE
Practice Address - Street 2:ROLLINGWOOD OFFICE PARK
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-5858
Practice Address - Country:US
Practice Address - Phone:916-988-2824
Practice Address - Fax:916-988-2824
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 16810101YM0800X
CAMFC30090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54220ZZZ54134ZOtherBLUE SHIELD