Provider Demographics
NPI:1942221130
Name:BERTOLUCCI, RAYNA (LCSW)
Entity Type:Individual
Prefix:
First Name:RAYNA
Middle Name:
Last Name:BERTOLUCCI
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 1:2205 HILLTOP DR STE 15
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0511
Mailing Address - Country:US
Mailing Address - Phone:530-221-2585
Mailing Address - Fax:530-221-2585
Practice Address - Street 1:1714 WEST ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1725
Practice Address - Country:US
Practice Address - Phone:530-949-0420
Practice Address - Fax:530-365-6752
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS221151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS22115OtherLISCENSE