Provider Demographics
NPI:1104940055
Name:GAGERMAN, JANICE RAYE (LCSW,BCD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:RAYE
Last Name:GAGERMAN
Suffix:
Gender:F
Credentials:LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 SANTIAGO CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-8781
Mailing Address - Country:US
Mailing Address - Phone:530-898-1952
Mailing Address - Fax:530-893-1153
Practice Address - Street 1:1430 ESPLANADE
Practice Address - Street 2:SUITE 17-C
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3366
Practice Address - Country:US
Practice Address - Phone:530-898-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 94201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW 9420OtherLICENSED CLINICAL SOCIAL