Provider Demographics
NPI:1740925049
Name:EKELEM, DENA MARCIA (MSW, ASW)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:MARCIA
Last Name:EKELEM
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13539 HATCHER PL
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-2945
Mailing Address - Country:US
Mailing Address - Phone:909-228-4464
Mailing Address - Fax:
Practice Address - Street 1:9567 ARROW RTE STE M
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4550
Practice Address - Country:US
Practice Address - Phone:909-774-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty