Healthcare Provider Details

I. General information

NPI: 1114264470
Provider Name (Legal Business Name): ROBERT FIERRO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 E COLORADO BLVD FL 2
PASADENA CA
91107-3840
US

IV. Provider business mailing address

112 HARVARD AVE NORTH # 9
CLAREMONT CA
91711-4716
US

V. Phone/Fax

Practice location:
  • Phone: 310-331-8152
  • Fax:
Mailing address:
  • Phone: 310-331-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number83708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: