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NPI Code Detail

MEDICARE: LORENA CARRASCO REYES LCSW

MEDICARE: LORENA CARRASCO REYES LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCSW96615CA

General Provider Information

NPI Number : 1255716502
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORENA CARRASCO REYES LCSW
Provider Business Mailing Address
First Line : 2130 N VENTURA RD
Second Line :
City : OXNARD
State : CA
Zip : 93036-2258
Country : US
Telephone Number : 510-317-1437
Fax Number :
Provider Business Practice Location Address
First Line : 2130 N VENTURA RD
Second Line :
City : OXNARD
State : CA
Zip : 93036-2258
Country : US
Telephone Number : 510-317-1437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2015
Last Update Date : 08/30/2020

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