Provider Demographics
NPI:1659589588
Name:AVITEA, LORENA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORENA
Middle Name:
Last Name:AVITEA
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 1:8080 LA MESA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0361
Mailing Address - Country:US
Mailing Address - Phone:619-884-8468
Mailing Address - Fax:619-342-4052
Practice Address - Street 1:8080 LA MESA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-884-8468
Practice Address - Fax:619-342-4052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 243781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical