Provider Demographics
NPI:1992987242
Name:MAST, DOLORES MARIA (LCSW 63286)
Entity type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:MARIA
Last Name:MAST
Suffix:
Gender:F
Credentials:LCSW 63286
Other - Prefix:MS
Other - First Name:DOLORES
Other - Middle Name:MARIA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17830 ARROW BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4037
Mailing Address - Country:US
Mailing Address - Phone:909-356-6415
Mailing Address - Fax:
Practice Address - Street 1:17830 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4037
Practice Address - Country:US
Practice Address - Phone:909-356-6451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 632861041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health