Provider Demographics
NPI:1497191233
Name:GELDRES-BECERRA, MARIA TERRY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:TERRY
Last Name:GELDRES-BECERRA
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 1:2705 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3389
Mailing Address - Country:US
Mailing Address - Phone:559-891-9003
Mailing Address - Fax:559-891-9005
Practice Address - Street 1:650 S ZEDIKER AVE
Practice Address - Street 2:
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2666
Practice Address - Country:US
Practice Address - Phone:559-646-3561
Practice Address - Fax:559-646-6676
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA869111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW86911OtherLICENSED CLINICAL SOCIAL WORKER