Provider Demographics
NPI:1720176837
Name:LUJAN, CHARLOTTE A (MSW)
Entity type:Individual
Prefix:MISS
First Name:CHARLOTTE
Middle Name:A
Last Name:LUJAN
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 1:17707 STUDEBAKER RD # 208
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2640
Mailing Address - Country:US
Mailing Address - Phone:562-402-0677
Mailing Address - Fax:564-467-7478
Practice Address - Street 1:17707 STUDEBAKER RD
Practice Address - Street 2:208
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2640
Practice Address - Country:US
Practice Address - Phone:562-402-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW11418101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health