Provider Demographics
NPI:1518399815
Name:BARRIOS, MARINA LORRAINE ((CADC-CAS))
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:LORRAINE
Last Name:BARRIOS
Suffix:
Gender:F
Credentials:(CADC-CAS)
Other - Prefix:MS
Other - First Name:MARINA
Other - Middle Name:LORRAINE
Other - Last Name:BARRIOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:(CADC-CAS)
Mailing Address - Street 1:1359 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1016
Mailing Address - Country:US
Mailing Address - Phone:626-430-2900
Mailing Address - Fax:626-331-0035
Practice Address - Street 1:1359 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1016
Practice Address - Country:US
Practice Address - Phone:626-430-2900
Practice Address - Fax:626-331-0035
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACS3140318101YM0800X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB0804271057OtherREGISTERED ADDICTION SPECIALIST
CACS3140318OtherCERTIFIED ALCOHOL AND DRUG COUNSELOR-ADDICTION SPECIALIST