Healthcare Provider Details

I. General information

NPI: 1245965367
Provider Name (Legal Business Name): JENNIFER MARIE WOOLF MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE SPEARS

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10929 SOUTH ST STE 208B
CERRITOS CA
90703-5391
US

IV. Provider business mailing address

PO BOX 131
LAKEWOOD CA
90714-0131
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-5526
  • Fax:
Mailing address:
  • Phone: 562-449-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109923
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number109923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: