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NPI Code Detail

MEDICARE: MS. JENNIFER HSU LARRATT-SMITH LCSW

MEDICARE: MS. JENNIFER HSU LARRATT-SMITH LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerSFF 7829CA
21041C0700XClinical Social WorkerLCSW 27665CA

General Provider Information

NPI Number : 1396877361
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER HSU LARRATT-SMITH LCSW
Provider Business Mailing Address
First Line : 5330 SAN BERNARDINO ST
Second Line :
City : MONTCLAIR
State : CA
Zip : 91763-2952
Country : US
Telephone Number : 909-399-3778
Fax Number :
Provider Business Practice Location Address
First Line : 5330 SAN BERNARDINO ST
Second Line :
City : MONTCLAIR
State : CA
Zip : 91763-2952
Country : US
Telephone Number : 909-399-3778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 10/08/2021

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