Provider Demographics
NPI:1437287646
Name:ORPHANOS, MAUREEN COSTELLO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:COSTELLO
Last Name:ORPHANOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39155 LIBERTY ST STE G710
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1525
Mailing Address - Country:US
Mailing Address - Phone:510-795-2434
Mailing Address - Fax:510-793-3972
Practice Address - Street 1:39155 LIBERTY ST STE G710
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1525
Practice Address - Country:US
Practice Address - Phone:510-795-2434
Practice Address - Fax:510-793-3972
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS187541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS18754OtherSOCIAL WORK LISCENSE