Provider Demographics
NPI:1447474176
Name:AVENDANO CLOUTIER, MARGO
Entity type:Individual
Prefix:MS
First Name:MARGO
Middle Name:
Last Name:AVENDANO CLOUTIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGIE
Other - Middle Name:
Other - Last Name:DELGADO AND MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045-0985
Mailing Address - Country:US
Mailing Address - Phone:831-623-2025
Mailing Address - Fax:
Practice Address - Street 1:255 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4717
Practice Address - Country:US
Practice Address - Phone:831-688-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52429106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist