Provider Demographics
NPI:1548299522
Name:MUSSETTO, DIONNE (LCSW)
Entity type:Individual
Prefix:MR
First Name:DIONNE
Middle Name:
Last Name:MUSSETTO
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:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-1098
Mailing Address - Country:US
Mailing Address - Phone:530-263-1033
Mailing Address - Fax:530-271-7404
Practice Address - Street 1:12183 LOCKSLEY LN
Practice Address - Street 2:SUITE 205
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2004
Practice Address - Country:US
Practice Address - Phone:530-263-1033
Practice Address - Fax:530-271-7404
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS210511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW210510Medicaid
CACSW210510Medicaid