Basic Information
Provider Information | |||||||||
NPI: | 1518399815 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARRIOS | ||||||||
FirstName: | MARINA | ||||||||
MiddleName: | LORRAINE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | (CADC-CAS) | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BARRIOS | ||||||||
OtherFirstName: | MARINA | ||||||||
OtherMiddleName: | LORRAINE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | (CADC-CAS) | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1359 N GRAND AVE | ||||||||
Address2: |   | ||||||||
City: | COVINA | ||||||||
State: | CA | ||||||||
PostalCode: | 917241016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6264302900 | ||||||||
FaxNumber: | 6263310035 | ||||||||
Practice Location | |||||||||
Address1: | 1359 N GRAND AVE | ||||||||
Address2: |   | ||||||||
City: | COVINA | ||||||||
State: | CA | ||||||||
PostalCode: | 917241016 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6264302900 | ||||||||
FaxNumber: | 6263310035 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/08/2013 | ||||||||
LastUpdateDate: | 04/25/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CS3140318 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | B0804271057 | 01 | CA | REGISTERED ADDICTION SPECIALIST | OTHER | CS3140318 | 01 | CA | CERTIFIED ALCOHOL AND DRUG COUNSELOR-ADDICTION SPECIALIST | OTHER |