Provider Demographics
NPI:1043804511
Name:ACOSTA-DUQUE, JOSHUA A (LCSE)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:ACOSTA-DUQUE
Suffix:
Gender:M
Credentials:LCSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3913
Mailing Address - Country:US
Mailing Address - Phone:909-475-8793
Mailing Address - Fax:909-886-4958
Practice Address - Street 1:5400 POMONA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1717
Practice Address - Country:US
Practice Address - Phone:323-837-2400
Practice Address - Fax:323-721-2437
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1215841041C0700X
CA99455101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical