Provider Demographics
NPI:1962289033
Name:LARIOS, AMANDA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:LARIOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S MINNEWAWA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4141
Mailing Address - Country:US
Mailing Address - Phone:559-691-6560
Mailing Address - Fax:
Practice Address - Street 1:645 S MINNEWAWA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4141
Practice Address - Country:US
Practice Address - Phone:559-691-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1255551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical