Provider Demographics
NPI:1730736919
Name:PONCE, RICARDO DE DIOS JR (LCSW)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:DE DIOS
Last Name:PONCE
Suffix:JR
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 1:909 CARLO DR
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1744
Mailing Address - Country:US
Mailing Address - Phone:805-705-2162
Mailing Address - Fax:
Practice Address - Street 1:1300 SARATOGA AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6401
Practice Address - Country:US
Practice Address - Phone:805-705-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW895651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical