Provider Demographics
NPI:1407490881
Name:CORONA, EILEEN ANNETTE
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:ANNETTE
Last Name:CORONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:ANNETTE
Other - Last Name:AMARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:136 FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-5330
Mailing Address - Country:US
Mailing Address - Phone:805-947-8180
Mailing Address - Fax:
Practice Address - Street 1:136 FRANK AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-5330
Practice Address - Country:US
Practice Address - Phone:805-947-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical