Provider Demographics
NPI:1508992884
Name:PUJOLS, MAUREEN LEDDY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:LEDDY
Last Name:PUJOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:VIRGINA
Other - Last Name:LEDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:268 W. HOSPITALITY LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0026
Mailing Address - Country:US
Mailing Address - Phone:909-421-9300
Mailing Address - Fax:909-382-3105
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
Practice Address - Country:US
Practice Address - Phone:909-421-9300
Practice Address - Fax:909-382-3105
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW20322104100000X, 1041C0700X
CALCS265311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker