Provider Demographics
NPI:1982413761
Name:AVILA, ROXANA (LCSW)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:AVILA
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 1:10331 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-6351
Mailing Address - Country:US
Mailing Address - Phone:714-663-6000
Mailing Address - Fax:
Practice Address - Street 1:10331 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-6351
Practice Address - Country:US
Practice Address - Phone:714-663-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230010467101YS0200X
CA1134481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical