Healthcare Provider Details

I. General information

NPI: 1659715092
Provider Name (Legal Business Name): JENNIFER LYNNE VAN LOY M.S.W., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2013
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 N ALAMEDA ST STE J&K
COMPTON CA
90222-1406
US

IV. Provider business mailing address

3209 N ALAMEDA ST STE J&K
COMPTON CA
90222-1406
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-5100
  • Fax:
Mailing address:
  • Phone: 213-385-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: