Healthcare Provider Details

I. General information

NPI: 1689179020
Provider Name (Legal Business Name): MONICA AQUINO PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 WILSON RD
BAKERSFIELD CA
93304-5319
US

IV. Provider business mailing address

222 34TH ST
BAKERSFIELD CA
93301-2234
US

V. Phone/Fax

Practice location:
  • Phone: 661-397-8775
  • Fax: 661-397-8286
Mailing address:
  • Phone: 661-631-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: