Provider Demographics
NPI:1457063166
Name:MIGLIORE, MARIA CARMELA (LCSW 111998)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARMELA
Last Name:MIGLIORE
Suffix:
Gender:F
Credentials:LCSW 111998
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S LUCIA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3509
Mailing Address - Country:US
Mailing Address - Phone:310-493-9654
Mailing Address - Fax:
Practice Address - Street 1:118 S LUCIA AVE APT 4
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3509
Practice Address - Country:US
Practice Address - Phone:310-493-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1119981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical