Basic Information
| Provider Information | |||||||||
| NPI: | 1447432703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEVAREZ | ||||||||
| FirstName: | JAVIER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6330 RUGBY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902556938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238266300 | ||||||||
| FaxNumber: | 3232777862 | ||||||||
| Practice Location | |||||||||
| Address1: | 6330 RUGBY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902556938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238266300 | ||||||||
| FaxNumber: | 3232777862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2007 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW29067 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.