Provider Demographics
NPI:1831075506
Name:CRYSTAL BARRERA LICENSED CLINICAL SOCIAL WORKER, INC.
Entity type:Organization
Organization Name:CRYSTAL BARRERA LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-606-3886
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-0024
Mailing Address - Country:US
Mailing Address - Phone:209-606-3886
Mailing Address - Fax:916-282-1692
Practice Address - Street 1:5170 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9608
Practice Address - Country:US
Practice Address - Phone:209-606-3886
Practice Address - Fax:916-282-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health