Healthcare Provider Details

I. General information

NPI: 1477960599
Provider Name (Legal Business Name): MAYRA A CORTES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

1756 S LEWIS RD
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-3669
  • Fax: 805-383-3692
Mailing address:
  • Phone: 805-383-3669
  • Fax: 805-383-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW82241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: