Provider Demographics
NPI:1881416659
Name:GRANADOS, MARITZA (ACSW, PPSC)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:ACSW, PPSC
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 816
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92693-0816
Mailing Address - Country:US
Mailing Address - Phone:949-374-4000
Mailing Address - Fax:
Practice Address - Street 1:700 AVENIDA PICO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5681
Practice Address - Country:US
Practice Address - Phone:949-401-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1241671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical