Provider Demographics
NPI:1821116898
Name:URIBE, TESCIA ROSE (LCSW, CPRP)
Entity Type:Individual
Prefix:MRS
First Name:TESCIA
Middle Name:ROSE
Last Name:URIBE
Suffix:
Gender:F
Credentials:LCSW, CPRP
Other - Prefix:MISS
Other - First Name:TESCIA
Other - Middle Name:ROSE
Other - Last Name:MARTLARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:456 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2426
Mailing Address - Country:US
Mailing Address - Phone:562-437-6717
Mailing Address - Fax:562-437-5072
Practice Address - Street 1:456 ELM AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2426
Practice Address - Country:US
Practice Address - Phone:562-437-6717
Practice Address - Fax:562-437-5072
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 225400000X
CALCS289221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner