Provider Demographics
NPI:1366885477
Name:BANUELOS, LINO (LCSW)
Entity type:Individual
Prefix:MR
First Name:LINO
Middle Name:
Last Name:BANUELOS
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 1:701 SCOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-7515
Mailing Address - Country:US
Mailing Address - Phone:661-758-8400
Mailing Address - Fax:
Practice Address - Street 1:701 SCOFIELD AVE
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-7515
Practice Address - Country:US
Practice Address - Phone:661-758-8400
Practice Address - Fax:661-758-7684
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical