Provider Demographics
NPI:1629348289
Name:CHAVARRIA, PABLO RIVERA (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:RIVERA
Last Name:CHAVARRIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:RIVERA
Other - Last Name:CHAVARRIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:10201 BRENTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3587
Mailing Address - Country:US
Mailing Address - Phone:661-665-1145
Mailing Address - Fax:
Practice Address - Street 1:10201 BRENTFORD AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3587
Practice Address - Country:US
Practice Address - Phone:661-665-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS160521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical