Provider Demographics
NPI:1922430545
Name:BELTRAN, JUANA (LCSW)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90651-1303
Mailing Address - Country:US
Mailing Address - Phone:562-381-5055
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:909-529-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW729671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-1946482Medicaid