Provider Demographics
NPI:1174746069
Name:FLORES-AVILA, MARLENE YESENIA (LCSW)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:YESENIA
Last Name:FLORES-AVILA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1011 BALDWIN PARK BLVD
Mailing Address - Street 2:EDUCATIONAL OUTREACH PROGRAM - BASEMENT
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5806
Mailing Address - Country:US
Mailing Address - Phone:626-851-6365
Mailing Address - Fax:626-851-5949
Practice Address - Street 1:1011 BALDWIN PARK BLVD
Practice Address - Street 2:EDUCATIONAL OUTREACH PROGRAM - BASEMENT
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5806
Practice Address - Country:US
Practice Address - Phone:626-851-6365
Practice Address - Fax:626-851-5949
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CALCS 221261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical