MEDICARE: TRENETTA DIANA JONES 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
1	1041C0700X	Clinical Social Worker	LCS 29061	CA

General Provider Information

NPI Number	:	1447590567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENETTA DIANA JONES LCSW

Provider Business Mailing Address
First Line	:	5710 W MANCHESTER AVE
Second Line	:	STE 210
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4423
Country	:	US
Telephone Number	:	323-377-7169
Fax Number	:

Provider Business Practice Location Address
First Line	:	5934 CIMARRON ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1008
Country	:	US
Telephone Number	:	323-377-7169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	01/03/2022

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