Provider Demographics
NPI:1457107260
Name:MURCIA, LOURDES (MSW/ACSW)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:MURCIA
Suffix:
Gender:F
Credentials:MSW/ACSW
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ACSW
Mailing Address - Street 1:444 S 8TH ST STE B3
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3236
Mailing Address - Country:US
Mailing Address - Phone:760-353-6571
Mailing Address - Fax:760-353-6281
Practice Address - Street 1:444 S 8TH ST STE B3
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3236
Practice Address - Country:US
Practice Address - Phone:760-353-6571
Practice Address - Fax:760-353-6281
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X, 251B00000X, 251X00000X
CA119712104100000X
CAC5BF-03-05-S24-018172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7617542Medicaid