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General NPI Number Information
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NPI Number | 1902164304
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Entity Type | Individual
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Provider Name | GLORIA ESTHER FONTES LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 29101 HOSPITAL RD
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352-9706
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Country | US
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Telephone | 909-436-3235
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Fax |
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Provider Business Mailing Address
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Address Line | 800 SCENIC DR
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City | MODESTO
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State | CA
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Zip | 95350-6131
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Country | US
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Telephone | 209-525-5157
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LCSW81836
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | ASW 30541
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW81836
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License Number State | CA
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