Provider Demographics
NPI:1720189392
Name:MADUENA, MARIA CARLOTA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:CARLOTA
Last Name:MADUENA
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 1:47825 OASIS ST.
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-863-8455
Mailing Address - Fax:760-863-8587
Practice Address - Street 1:47825 OASIS ST.
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-863-8455
Practice Address - Fax:760-863-8587
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS243121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical