Provider Demographics
NPI:1144286808
Name:FUGAL, RHEA W (LCSW)
Entity type:Individual
Prefix:MS
First Name:RHEA
Middle Name:W
Last Name:FUGAL
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 1:2251 CASA ALTA
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-7014
Mailing Address - Country:US
Mailing Address - Phone:619-741-3283
Mailing Address - Fax:619-741-3283
Practice Address - Street 1:5480 BALTIMORE DR STE 103
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2068
Practice Address - Country:US
Practice Address - Phone:619-741-3283
Practice Address - Fax:619-741-3283
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 23608251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ11879Medicare UPIN
UT005732304Medicare ID - Type Unspecified