Provider Demographics
NPI:1639981897
Name:ESPINOZA GARCIA, MARISOL (ACSW 123201)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:ESPINOZA GARCIA
Suffix:
Gender:F
Credentials:ACSW 123201
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21810 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5810
Mailing Address - Country:US
Mailing Address - Phone:909-580-5006
Mailing Address - Fax:
Practice Address - Street 1:21810 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5810
Practice Address - Country:US
Practice Address - Phone:909-580-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041S0200X
CA1232011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool