Provider Demographics
NPI:1962509273
Name:FLORES, MICAELA VICTORIA M (LCSW)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:VICTORIA M
Last Name:FLORES
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 1:503 1/2 S MYRTLE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5100
Mailing Address - Country:US
Mailing Address - Phone:626-840-1435
Mailing Address - Fax:
Practice Address - Street 1:503 1/2 S MYRTLE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5100
Practice Address - Country:US
Practice Address - Phone:626-840-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 222661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMF9866OtherCOUNTY STAFF CODE