Provider Demographics
NPI:1124748348
Name:NAVARRO, MARITZA JUDITH (LGSW)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:JUDITH
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 TOWN SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6088
Mailing Address - Country:US
Mailing Address - Phone:507-323-8100
Mailing Address - Fax:833-974-2090
Practice Address - Street 1:1415 TOWN SQUARE LN
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6088
Practice Address - Country:US
Practice Address - Phone:507-323-8100
Practice Address - Fax:833-974-2090
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN313531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31353OtherMINNESOTA BOARD OF SOCIAL WORK