Provider Demographics
NPI:1417096512
Name:YAGI, TOYOKO TRACY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TOYOKO
Middle Name:TRACY
Last Name:YAGI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TOYOKO
Other - Middle Name:
Other - Last Name:YAGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-421-9200
Mailing Address - Fax:909-421-9219
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9200
Practice Address - Fax:909-421-9219
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS260321041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker