Provider Demographics
NPI:1639308547
Name:COVARRUBIAS, DOLORES R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:R
Last Name:COVARRUBIAS
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 1:1320 STANDIFORD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0726
Mailing Address - Country:US
Mailing Address - Phone:209-557-1177
Mailing Address - Fax:209-557-1083
Practice Address - Street 1:1320 STANDIFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0726
Practice Address - Country:US
Practice Address - Phone:209-557-1177
Practice Address - Fax:209-557-1083
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 257021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical