Provider Demographics
NPI:1285016683
Name:ESPARZA, MARDENE ANGELICA (LCSW 99109)
Entity type:Individual
Prefix:
First Name:MARDENE
Middle Name:ANGELICA
Last Name:ESPARZA
Suffix:
Gender:
Credentials:LCSW 99109
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 ANDERS CIR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2304
Mailing Address - Country:US
Mailing Address - Phone:619-857-1218
Mailing Address - Fax:
Practice Address - Street 1:7901 ANDERS CIR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2304
Practice Address - Country:US
Practice Address - Phone:619-857-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA991091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator