Provider Demographics
NPI:1831486224
Name:ESTRADA, MARIANA ISIS (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:ISIS
Last Name:ESTRADA
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 1:155 N LAKE AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1857
Mailing Address - Country:US
Mailing Address - Phone:626-660-9505
Mailing Address - Fax:
Practice Address - Street 1:155 N LAKE AVE STE 800
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1857
Practice Address - Country:US
Practice Address - Phone:626-660-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW747931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical