Provider Demographics
NPI:1669955431
Name:MARENCO MIRANDA, FRANCELA M (ASW)
Entity type:Individual
Prefix:
First Name:FRANCELA
Middle Name:M
Last Name:MARENCO MIRANDA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 BLACKOAK DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3018
Mailing Address - Country:US
Mailing Address - Phone:510-648-4194
Mailing Address - Fax:
Practice Address - Street 1:24301 SOUTHLAND DR STE 207
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1541
Practice Address - Country:US
Practice Address - Phone:510-826-9209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91074104100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program