Provider Demographics
NPI:1568751394
Name:CALATAYUD, MARICELA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARICELA
Middle Name:
Last Name:CALATAYUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 W MAIN ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1694
Mailing Address - Country:US
Mailing Address - Phone:626-284-7818
Mailing Address - Fax:626-458-8138
Practice Address - Street 1:2550 W MAIN ST
Practice Address - Street 2:SUITE #102
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-284-7818
Practice Address - Fax:626-458-8138
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 147051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical