Provider Demographics
NPI:1982801528
Name:ESTRADA, FERNANDO (LCSW)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S ATHENS AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5010
Mailing Address - Country:US
Mailing Address - Phone:928-246-1525
Mailing Address - Fax:928-783-0334
Practice Address - Street 1:1600 S ATHENS AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-5010
Practice Address - Country:US
Practice Address - Phone:928-246-1525
Practice Address - Fax:928-783-0334
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical