Provider Demographics
NPI:1962781294
Name:PEDRO, VIRGIL JOSEPH (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGIL
Middle Name:JOSEPH
Last Name:PEDRO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 MAGNOLIA AVENUE
Mailing Address - Street 2:SHERMAN INDIAN HIGH SCHOOL
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4431
Mailing Address - Country:US
Mailing Address - Phone:951-509-8780
Mailing Address - Fax:951-509-8933
Practice Address - Street 1:9010 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4431
Practice Address - Country:US
Practice Address - Phone:951-509-8780
Practice Address - Fax:951-509-8933
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-19341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical