Provider Demographics
NPI:1306957873
Name:MARTICORENA, MARIA ELENA (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA ELENA
Middle Name:
Last Name:MARTICORENA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHAMBERLIN CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-2515
Mailing Address - Country:US
Mailing Address - Phone:916-667-2706
Mailing Address - Fax:916-667-2706
Practice Address - Street 1:5000 CHAMBERLIN CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-2515
Practice Address - Country:US
Practice Address - Phone:916-667-2706
Practice Address - Fax:916-667-2706
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20415OtherASW