Provider Demographics
NPI:1144439746
Name:NIETO, FRANK (MSW)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:NIETO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8813 ROUNDTABLE CT
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6430
Mailing Address - Country:US
Mailing Address - Phone:916-967-7255
Mailing Address - Fax:
Practice Address - Street 1:3330 HEIGHTS DR
Practice Address - Street 2:STE 120
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7769
Practice Address - Country:US
Practice Address - Phone:530-677-4404
Practice Address - Fax:530-677-4545
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS69191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32335ZMedicare ID - Type Unspecified