Provider Demographics
NPI:1396127809
Name:MARITZA NIGRO, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity type:Organization
Organization Name:MARITZA NIGRO, LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-437-3605
Mailing Address - Street 1:223 S GLENDORA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3442
Mailing Address - Country:US
Mailing Address - Phone:626-437-3605
Mailing Address - Fax:
Practice Address - Street 1:223 S GLENDORA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3442
Practice Address - Country:US
Practice Address - Phone:626-437-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497903017Medicare PIN