Provider Demographics
NPI:1801216833
Name:MARSHALL, VERONICA CONCEPCION (LCSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:CONCEPCION
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:CONCEPCION
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7587 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0124
Mailing Address - Country:US
Mailing Address - Phone:562-991-3033
Mailing Address - Fax:
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9470
Practice Address - Fax:909-873-4461
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68286101Y00000X
CA897751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor