Provider Demographics
NPI:1306736525
Name:ADRIMAR PRACTICE LICENSED CLINICAL SOCIAL WORKER PC
Entity type:Organization
Organization Name:ADRIMAR PRACTICE LICENSED CLINICAL SOCIAL WORKER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJORQUEZ NAVARRETE
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW
Authorized Official - Phone:626-384-6940
Mailing Address - Street 1:PO BOX 3411
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-3411
Mailing Address - Country:US
Mailing Address - Phone:909-999-3957
Mailing Address - Fax:
Practice Address - Street 1:9431 HAVEN AVE STE 232
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5883
Practice Address - Country:US
Practice Address - Phone:909-999-3957
Practice Address - Fax:844-444-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)