Provider Demographics
NPI:1316218266
Name:GUEVARA, JUANITA MARIA ANGELICA (LCSW)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:MARIA ANGELICA
Last Name:GUEVARA
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 1:7365 CARNELLAN ST.
Mailing Address - Street 2:STE. 202
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1158
Mailing Address - Country:US
Mailing Address - Phone:909-758-7275
Mailing Address - Fax:877-850-5695
Practice Address - Street 1:7365 CARNELLAN ST.
Practice Address - Street 2:STE. 202
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1158
Practice Address - Country:US
Practice Address - Phone:909-758-7275
Practice Address - Fax:877-850-5695
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW833201041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health