Provider Demographics
NPI:1467994319
Name:FLETCHER, MAE-GHAN DELFIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAE-GHAN
Middle Name:DELFIN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MAE-GHAN
Other - Middle Name:CALDEO
Other - Last Name:DELFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11401 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2015
Mailing Address - Country:US
Mailing Address - Phone:562-863-7011
Mailing Address - Fax:562-864-4560
Practice Address - Street 1:11401 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-863-7011
Practice Address - Fax:562-864-4560
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical