Provider Demographics
NPI:1265679872
Name:AVARELL, VERNA JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VERNA
Middle Name:JEAN
Last Name:AVARELL
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:PO BOX 1502
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-1502
Mailing Address - Country:US
Mailing Address - Phone:909-337-3366
Mailing Address - Fax:
Practice Address - Street 1:27482 NORTH BAY ROAD
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-1502
Practice Address - Country:US
Practice Address - Phone:909-337-3366
Practice Address - Fax:909-337-0242
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 251041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical