Provider Demographics
NPI:1962955666
Name:CHOR FREITAS, MIRIAM (LCSW)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:CHOR FREITAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12915 CREEK PARK DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5762
Mailing Address - Country:US
Mailing Address - Phone:858-842-1114
Mailing Address - Fax:
Practice Address - Street 1:12929 POMERADO RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5325
Practice Address - Country:US
Practice Address - Phone:858-842-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical