MEDICARE: MARIBEL DE AVILA 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
1	1041C0700X	Clinical Social Worker	LCSW94273	CA

General Provider Information

NPI Number	:	1538395884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIBEL DE AVILA LCSW

Provider Business Mailing Address
First Line	:	1120 W LA VETA AVE STE 660
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4244
Country	:	US
Telephone Number	:	562-321-8138
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 W LA VETA AVE STE 660
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4244
Country	:	US
Telephone Number	:	562-321-8138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	10/02/2023

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