Healthcare Provider Details

I. General information

NPI: 1740184381
Provider Name (Legal Business Name): MARIPOSA EMPOWERMENT LICENSED CLINICAL SOCIAL WORKER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 AMBERWOOD DR APT 7
SOUTH PASADENA CA
91030-1957
US

IV. Provider business mailing address

1653 AMBERWOOD DR APT 7
SOUTH PASADENA CA
91030-1957
US

V. Phone/Fax

Practice location:
  • Phone: 323-547-0598
  • Fax:
Mailing address:
  • Phone: 323-547-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LENORE CARMEN PALLARES
Title or Position: PRESIDENT
Credential: LCSW
Phone: 323-547-0598