Provider Demographics
NPI:1780282186
Name:DE OLIVEIRA, RAQUEL Y (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:Y
Last Name:DE OLIVEIRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:Y
Other - Last Name:SANTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 S LEMON AVE # 9892
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2706
Mailing Address - Country:US
Mailing Address - Phone:415-651-3458
Mailing Address - Fax:
Practice Address - Street 1:2550 SE WALTON RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7168
Practice Address - Country:US
Practice Address - Phone:772-335-0400
Practice Address - Fax:772-238-7670
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW145791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical