Provider Demographics
NPI:1649220559
Name:PIZANO-HAZAMA, RAQUEL BELEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:BELEN
Last Name:PIZANO-HAZAMA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:RAQUEL
Other - Middle Name:BELEN
Other - Last Name:PIZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91778-0553
Mailing Address - Country:US
Mailing Address - Phone:626-786-0341
Mailing Address - Fax:626-398-6879
Practice Address - Street 1:625 FAIR OAKS AVE
Practice Address - Street 2:SUITE 374
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2630
Practice Address - Country:US
Practice Address - Phone:626-786-0341
Practice Address - Fax:626-398-6879
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS161311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical