Provider Demographics
NPI:1629613963
Name:SANTOS, MARI ZOL (LCSW)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:ZOL
Last Name:SANTOS
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 1:9668 MILLIKEN AVE STE 104-183
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6137
Mailing Address - Country:US
Mailing Address - Phone:626-692-5954
Mailing Address - Fax:909-476-0138
Practice Address - Street 1:9668 MILLIKEN AVE STE 104-183
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6137
Practice Address - Country:US
Practice Address - Phone:626-692-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1146311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical