Provider Demographics
NPI:1699800730
Name:DELACUESTA, DEBORA MARIE (MSW)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:MARIE
Last Name:DELACUESTA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16052 BEACH BLVD
Mailing Address - Street 2:STE 228
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3801
Mailing Address - Country:US
Mailing Address - Phone:714-841-3465
Mailing Address - Fax:714-841-1882
Practice Address - Street 1:16052 BEACH BLVD
Practice Address - Street 2:STE 228
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3801
Practice Address - Country:US
Practice Address - Phone:714-841-3465
Practice Address - Fax:714-841-1882
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS11278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR369338Medicare UPIN
CASW11278Medicare ID - Type Unspecified