Provider Demographics
NPI:1669831830
Name:DEL RIO, MARITZA MARTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:MARTIN
Last Name:DEL RIO
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:PO BOX 1781
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1781
Mailing Address - Country:US
Mailing Address - Phone:909-992-8928
Mailing Address - Fax:
Practice Address - Street 1:123 E 9TH ST STE 100-A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6023
Practice Address - Country:US
Practice Address - Phone:909-992-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA882961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical