Provider Demographics
NPI:1720569833
Name:SALAZAR, MARIA DE JESUS (ACSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE JESUS
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 E PALMDALE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2029
Mailing Address - Country:US
Mailing Address - Phone:661-272-9996
Mailing Address - Fax:
Practice Address - Street 1:1529 E PALMDALE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2029
Practice Address - Country:US
Practice Address - Phone:661-272-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW84245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health