Provider Demographics
NPI:1326625112
Name:FLOCKHART, MARIA JOSE (LCSW, MSW, MED)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSE
Last Name:FLOCKHART
Suffix:
Gender:F
Credentials:LCSW, MSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11835 CARMEL MOUNTAIN RD STE 1304-209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4609
Mailing Address - Country:US
Mailing Address - Phone:619-607-3323
Mailing Address - Fax:
Practice Address - Street 1:11835 CARMEL MOUNTAIN RD STE 1304-209
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4609
Practice Address - Country:US
Practice Address - Phone:619-607-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical