Provider Demographics
NPI:1043619380
Name:CORTEZ, FANNY (LCSW)
Entity Type:Individual
Prefix:
First Name:FANNY
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 E ASHLAN AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3021
Mailing Address - Country:US
Mailing Address - Phone:209-470-7596
Mailing Address - Fax:
Practice Address - Street 1:4910 E ASHLAN AVE STE 118
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3021
Practice Address - Country:US
Practice Address - Phone:209-470-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72235101YP2500X, 1041C0700X
CA995081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional