Provider Demographics
NPI:1487752838
Name:MUSICK-VINYARD, CATHERINE A (LCSW)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:MUSICK-VINYARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3359 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6820
Mailing Address - Country:US
Mailing Address - Phone:919-345-5174
Mailing Address - Fax:
Practice Address - Street 1:7471 RUDELL RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4278
Practice Address - Country:US
Practice Address - Phone:919-345-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0040721041C0700X
CA75791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003041Medicaid