Provider Demographics
NPI:1871976332
Name:MACIAS, JOSE JUAN (LCSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JUAN
Last Name:MACIAS
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 1:13442 BRACKEN ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5707
Mailing Address - Country:US
Mailing Address - Phone:213-618-0322
Mailing Address - Fax:
Practice Address - Street 1:13442 BRACKEN ST
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-5707
Practice Address - Country:US
Practice Address - Phone:213-618-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 245531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical