Provider Demographics
NPI:1114669603
Name:BORBA, NICOLE MARGIT
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARGIT
Last Name:BORBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DUTRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, ASW
Mailing Address - Street 1:1742 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1717
Mailing Address - Country:US
Mailing Address - Phone:530-646-7269
Mailing Address - Fax:
Practice Address - Street 1:1742 OREGON ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1717
Practice Address - Country:US
Practice Address - Phone:530-646-7269
Practice Address - Fax:530-275-2201
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical