Provider Demographics
NPI:1205246139
Name:DURAN, VANESSA (LCSW, BCD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:RAULSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, BCD
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-532-7150
Mailing Address - Fax:
Practice Address - Street 1:209 JOURNEYS END
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7680
Practice Address - Country:US
Practice Address - Phone:760-622-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT0094081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN