| Digna Rivera Woolum Licensed Clinical Social Worker Inc A Prof | |
|
1255 W Colton Ave Redlands CA 92374-2861 | |
| (661) 390-6874 | |
| Not Available |
| Full Name | Digna Rivera Woolum Licensed Clinical Social Worker Inc A Prof |
|---|---|
| Speciality | Social Worker |
| Location | 1255 W Colton Ave, Redlands, California |
| Authorized Official Name and Position | Digna Rocio Rivera Woolum (DIRECTOR/PROVIDER) |
| Authorized Official Contact | 6613906874 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Digna Rivera Woolum Licensed Clinical Social Worker Inc A Prof 201 Brookside Ave. #402 Redlands CA 92373-2517 Ph: (661) 390-6874 | Digna Rivera Woolum Licensed Clinical Social Worker Inc A Prof 1255 W Colton Ave Redlands CA 92374-2861 Ph: (661) 390-6874 |
| NPI Number | 1255954558 |
|---|---|
| Provider Enumeration Date | 05/20/2020 |
| Last Update Date | 10/29/2020 |
| Certification Date | 09/12/2020 |
| Medicare PECOS PAC ID | 8426471376 |
|---|---|
| Medicare Enrollment ID | O20200710000136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255954558 | NPI | - | NPPES |
| 91473 | Other | CA | BOARD OF BEHAVIORAL SCIENCES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Digna Rocio Rivera Woolum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265952550 PECOS PAC ID: 0244653194 Enrollment ID: I20200710000243 |
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