Provider Demographics
NPI:1861938557
Name:GUERRERO, SHIZATIZ (LCSW)
Entity type:Individual
Prefix:
First Name:SHIZATIZ
Middle Name:
Last Name:GUERRERO
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 1:1104 S PRICEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-5235
Mailing Address - Country:US
Mailing Address - Phone:626-250-3291
Mailing Address - Fax:
Practice Address - Street 1:9500 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-980-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2023-12-28
Deactivation Date:2018-07-24
Deactivation Code:
Reactivation Date:2018-08-15
Provider Licenses
StateLicense IDTaxonomies
CA84252101YM0800X
171M00000X
CA1054451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator