Healthcare Provider Details

I. General information

NPI: 1952223489
Provider Name (Legal Business Name): LUZ MENTAL HEALTH, LICENSE CLINICAL SOCIAL WORKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 E CLARK AVE STE C
SANTA MARIA CA
93455-5145
US

IV. Provider business mailing address

PO BOX 1860
LOMPOC CA
93438-1860
US

V. Phone/Fax

Practice location:
  • Phone: 805-724-0385
  • Fax:
Mailing address:
  • Phone: 805-724-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARITZA BARRON-VACA
Title or Position: OWNER
Credential: LCSW
Phone: 805-724-0385