Provider Demographics
NPI:1811679533
Name:AGUAYO, ROXANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:AGUAYO
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:PO BOX 8642
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93747-8642
Mailing Address - Country:US
Mailing Address - Phone:559-704-3546
Mailing Address - Fax:
Practice Address - Street 1:2315 E ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2219
Practice Address - Country:US
Practice Address - Phone:559-459-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA992601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical