Provider Demographics
NPI:1629061551
Name:NAVARRETE, HOLLY E (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:NAVARRETE
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 1:5055 CANYON CREST DR STE 225
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6015
Mailing Address - Country:US
Mailing Address - Phone:951-818-4560
Mailing Address - Fax:951-346-3783
Practice Address - Street 1:5055 CANYON CREST DR STE 225
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6015
Practice Address - Country:US
Practice Address - Phone:951-818-4560
Practice Address - Fax:951-346-3783
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS187291041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS18729Medicaid