Provider Demographics
NPI:1396041232
Name:MERAZ, HENRY LUGO JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LUGO
Last Name:MERAZ
Suffix:JR
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 1:8616 N GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3975
Mailing Address - Country:US
Mailing Address - Phone:559-824-3779
Mailing Address - Fax:559-705-1936
Practice Address - Street 1:6777 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5900
Practice Address - Country:US
Practice Address - Phone:559-824-3779
Practice Address - Fax:559-705-1936
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72943101YM0800X, 1041C0700X
CA313461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800677527Medicaid