Healthcare Provider Details

I. General information

NPI: 1215337936
Provider Name (Legal Business Name): JENNEVA BARRETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N AVIATION BLVD BLDG 210
EL SEGUNDO CA
90245-2808
US

IV. Provider business mailing address

483 N AVIATION BLVD BLDG 210
EL SEGUNDO CA
90245-2808
US

V. Phone/Fax

Practice location:
  • Phone: 310-653-6860
  • Fax:
Mailing address:
  • Phone: 310-653-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2014015202
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2016041692
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: