Healthcare Provider Details

I. General information

NPI: 1205131562
Provider Name (Legal Business Name): ANDRES ESTRADA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W ROUTE 66
GLENDORA CA
91740-6207
US

IV. Provider business mailing address

PO BOX 1782
GLENDORA CA
91740-1782
US

V. Phone/Fax

Practice location:
  • Phone: 626-852-6153
  • Fax:
Mailing address:
  • Phone: 626-852-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: