Healthcare Provider Details

I. General information

NPI: 1144476474
Provider Name (Legal Business Name): ERIK JAMES ESCARENO DSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 HAVEN AVE STE 100
RANCHO CUCAMONGA CA
91730-5879
US

IV. Provider business mailing address

1042 N MOUNTAIN AVE STE B
UPLAND CA
91786-3695
US

V. Phone/Fax

Practice location:
  • Phone: 909-529-8965
  • Fax:
Mailing address:
  • Phone: 562-298-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22006
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: