Provider Demographics
NPI:1942687140
Name:CAZARES, ANDRES (ASW)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:CAZARES
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5905
Mailing Address - Country:US
Mailing Address - Phone:707-556-8100
Mailing Address - Fax:707-556-8107
Practice Address - Street 1:243 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5905
Practice Address - Country:US
Practice Address - Phone:707-556-8100
Practice Address - Fax:707-556-8107
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66139104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker