Provider Demographics
NPI:1902164304
Name:FONTES, GLORIA ESTHER (LCSW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ESTHER
Last Name:FONTES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ESTHER
Other - Last Name:BAEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:800 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6131
Mailing Address - Country:US
Mailing Address - Phone:209-525-5157
Mailing Address - Fax:
Practice Address - Street 1:29101 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-9706
Practice Address - Country:US
Practice Address - Phone:909-436-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW81836101Y00000X, 1041C0700X
CAASW 30541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional