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NPI Code Detail

MEDICARE: MS. BETH JAKUBANIS LCSW

MEDICARE: MS. BETH JAKUBANIS 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
11041C0700XClinical Social WorkerLCS 28234CA
21041S0200XSchool Social WorkerLCS 28234CA

General Provider Information

NPI Number : 1700079191
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BETH JAKUBANIS LCSW
Provider Business Mailing Address
First Line : 1611 E LOS ANGELES AVE
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-2019
Country : US
Telephone Number : 805-443-8619
Fax Number :
Provider Business Practice Location Address
First Line : 1611 E LOS ANGELES AVE
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93065-2019
Country : US
Telephone Number : 805-443-8619
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2007
Last Update Date : 06/04/2013

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