Healthcare Provider Details

I. General information

NPI: 1144874785
Provider Name (Legal Business Name): VALERIA SOPHIA LARA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 BUSINESS CENTER DR # 200
SAN BERNARDINO CA
92408-3436
US

IV. Provider business mailing address

1908 BUSINESS CENTER DR STE 220
SAN BERNARDINO CA
92408-3468
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-5930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102450
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136057
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number102450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: