Provider Demographics
NPI:1689853400
Name:RIVERA-GOIN, VICKI S M (LCSW)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:S M
Last Name:RIVERA-GOIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:S
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:395 W NAPA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6548
Mailing Address - Country:US
Mailing Address - Phone:707-812-2547
Mailing Address - Fax:
Practice Address - Street 1:395 W NAPA ST STE 3
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6548
Practice Address - Country:US
Practice Address - Phone:707-812-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS235881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110000251OtherSTATE LICENSE
CAFHC53855FMedicaid
CAFHC53855FMedicaid
CA55-1945Medicare PIN
CA55-1943Medicare PIN