Provider Demographics
NPI:1083862791
Name:FLORESISLAS, MERCEDES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:
Last Name:FLORESISLAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:FLORESISLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:11875 PIGEON PASS ROAD
Mailing Address - Street 2:B-13 #345
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1339 20TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2033
Practice Address - Country:US
Practice Address - Phone:310-829-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27311104100000X
CALCSW652361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker