Provider Demographics
NPI:1518362771
Name:FLORES, MARIA CLARA (MSS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CLARA
Last Name:FLORES
Suffix:
Gender:F
Credentials:MSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 S FARRAGUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3606
Mailing Address - Country:US
Mailing Address - Phone:215-429-2868
Mailing Address - Fax:
Practice Address - Street 1:913 S FARRAGUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3606
Practice Address - Country:US
Practice Address - Phone:215-429-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA47-2100023OtherEIN