Healthcare Provider Details

I. General information

NPI: 1033318316
Provider Name (Legal Business Name): JENNIFER JEWERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 E MAIN ST
BARSTOW CA
92311-3234
US

IV. Provider business mailing address

1841 E MAIN ST
BARSTOW CA
92311-3234
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: