Provider Demographics
NPI:1811525348
Name:HENRIQUEZ, IRENE CLAUDIA (ASW)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:CLAUDIA
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:CLAUDIA
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3914 W NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8994
Mailing Address - Country:US
Mailing Address - Phone:559-798-5491
Mailing Address - Fax:
Practice Address - Street 1:520 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-3629
Practice Address - Country:US
Practice Address - Phone:559-623-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 171M00000X
CAASW119971104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator