Provider Demographics
NPI:1023136223
Name:TABA, PATIENCE TSURUKO (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATIENCE
Middle Name:TSURUKO
Last Name:TABA
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 1:775 SUNRISE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4527
Mailing Address - Country:US
Mailing Address - Phone:916-600-2838
Mailing Address - Fax:916-773-0965
Practice Address - Street 1:775 SUNRISE AVE STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4527
Practice Address - Country:US
Practice Address - Phone:916-600-2838
Practice Address - Fax:916-773-0965
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 209411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical