=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518271600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FATIMA AGREGADO, LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2010
-----------------------------------------------------
Last Update Date | 07/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 E LEMON AVE SUITE 214
-----------------------------------------------------
City | MONROVIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91016-5115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-303-0707
-----------------------------------------------------
Fax | 626-303-7677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 E LEMON AVE SUITE 214
-----------------------------------------------------
City | MONROVIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91016-5115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-303-0707
-----------------------------------------------------
Fax | 626-303-7677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MS. FATIMA OPINA AGREGADO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 626-733-7052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS 23171
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------