Provider Demographics
NPI:1427345362
Name:MANRIQUEZ, MONIQUE QUITORIANO (LCSW)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:QUITORIANO
Last Name:MANRIQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:JOHANNA
Other - Last Name:QUITORIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4400 NE 77TH AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6857
Mailing Address - Country:US
Mailing Address - Phone:951-394-2388
Mailing Address - Fax:
Practice Address - Street 1:10532 ACACIA ST STE B4
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5455
Practice Address - Country:US
Practice Address - Phone:909-248-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCSW818971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health