Provider Demographics
NPI:1669055075
Name:PADDOCK, NATASHA (ASW)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:PADDOCK
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 1:2872 YGNACIO VALLEY RD # 112
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3534
Mailing Address - Country:US
Mailing Address - Phone:925-408-8415
Mailing Address - Fax:
Practice Address - Street 1:1070 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5699
Practice Address - Country:US
Practice Address - Phone:925-849-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94484390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program