Healthcare Provider Details

I. General information

NPI: 1235546870
Provider Name (Legal Business Name): MARLENE CUEVAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 REDHILL AVE STE 100
SANTA ANA CA
92705-5518
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 300
ORANGE CA
92868-3219
US

V. Phone/Fax

Practice location:
  • Phone: 949-267-0400
  • Fax:
Mailing address:
  • Phone: 714-456-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: