Provider Demographics
NPI:1265936793
Name:RAINEY, JASMINKA (ASW)
Entity type:Individual
Prefix:
First Name:JASMINKA
Middle Name:
Last Name:RAINEY
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 S ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-7155
Mailing Address - Country:US
Mailing Address - Phone:916-628-4042
Mailing Address - Fax:
Practice Address - Street 1:1412 S ST STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-7155
Practice Address - Country:US
Practice Address - Phone:916-628-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80212OtherBOARD OF BEHAVIORAL SCIENCES