Provider Demographics
NPI:1356683239
Name:MARQUEZ, ROBERT A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:MARQUEZ
Suffix:
Gender:M
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 733
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92247-0733
Mailing Address - Country:US
Mailing Address - Phone:559-288-7690
Mailing Address - Fax:760-698-8115
Practice Address - Street 1:53848 AVENIDA JUAREZ
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3593
Practice Address - Country:US
Practice Address - Phone:760-698-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical