Provider Demographics
NPI:1558430595
Name:PRADO BORREGO, MARGARITA (MFT LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:PRADO BORREGO
Suffix:
Gender:F
Credentials:MFT LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N CHINOWTH
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-625-2449
Mailing Address - Fax:559-625-1319
Practice Address - Street 1:1106 N CHINOWTH
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-625-2449
Practice Address - Fax:559-625-1319
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 84321041C0700X
CAMFC 17527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16752ZMedicare ID - Type Unspecified