Healthcare Provider Details

I. General information

NPI: 1952176281
Provider Name (Legal Business Name): IRIS JAN DUARTE MSW, LCSW 13225
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MCKELVY AVE
CLOVIS CA
93611-5413
US

IV. Provider business mailing address

374 MCKELVY AVE
CLOVIS CA
93611-5413
US

V. Phone/Fax

Practice location:
  • Phone: 559-392-4701
  • Fax:
Mailing address:
  • Phone: 559-392-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: