Provider Demographics
NPI:1427276013
Name:ISIDRO, FIDES G (LCSW)
Entity type:Individual
Prefix:MS
First Name:FIDES
Middle Name:G
Last Name:ISIDRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DESI
Other - Middle Name:
Other - Last Name:ISIDRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:11152 WALLINGSFORD RD APT 7C
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3089
Mailing Address - Country:US
Mailing Address - Phone:908-494-2338
Mailing Address - Fax:
Practice Address - Street 1:11152 WALLINGSFORD RD APT 7C
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3089
Practice Address - Country:US
Practice Address - Phone:908-494-2338
Practice Address - Fax:562-296-8105
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052878001041C0700X
NY080981-011041C0700X
CALCSW1100051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical