Provider Demographics
NPI:1518271600
Name:FATIMA AGREGADO, LCSW
Entity Type:Organization
Organization Name:FATIMA AGREGADO, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:OPINA
Authorized Official - Last Name:AGREGADO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-733-7052
Mailing Address - Street 1:103 E LEMON AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5115
Mailing Address - Country:US
Mailing Address - Phone:626-303-0707
Mailing Address - Fax:626-303-7677
Practice Address - Street 1:103 E LEMON AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5115
Practice Address - Country:US
Practice Address - Phone:626-303-0707
Practice Address - Fax:626-303-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 231711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty