Basic Information
| Provider Information | |||||||||
| NPI: | 1386816478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARON | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | TILLEY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13666 E. 14TH STREET. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103575515 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13666 E. 14TH STREET. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103575515 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2008 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 62418 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.