Provider Demographics
NPI:1770732000
Name:JUAREZ, NATALIE RUTH (LCSW, PPS)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:RUTH
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:LCSW, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11627 BROOKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4911
Mailing Address - Country:US
Mailing Address - Phone:562-904-3589
Mailing Address - Fax:
Practice Address - Street 1:11627 BROOKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4911
Practice Address - Country:US
Practice Address - Phone:562-904-3589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 390200000X
CALCSW659011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program