Provider Demographics
NPI:1093543878
Name:GAMBOA, MARLENE (ACSW)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5348
Mailing Address - Country:US
Mailing Address - Phone:909-450-4951
Mailing Address - Fax:
Practice Address - Street 1:451 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-5348
Practice Address - Country:US
Practice Address - Phone:909-450-4951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1168911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical