Provider Demographics
NPI:1851790968
Name:JUAREZ, ESTEBAN (LCSW #28425)
Entity Type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:M
Credentials:LCSW #28425
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-6100
Mailing Address - Country:US
Mailing Address - Phone:949-764-5947
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE F107
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4623
Practice Address - Country:US
Practice Address - Phone:714-618-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical