Provider Demographics
NPI:1891818670
Name:TIRADO, RAQUEL IRENE (CADC-CAS)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:IRENE
Last Name:TIRADO
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E HERNDON AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3149
Mailing Address - Country:US
Mailing Address - Phone:559-803-1298
Mailing Address - Fax:
Practice Address - Street 1:2212 N WINERY AVE STE 122
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2896
Practice Address - Country:US
Practice Address - Phone:559-803-1298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC12741214101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)