Healthcare Provider Details

I. General information

NPI: 1528396538
Provider Name (Legal Business Name): JENNIFER LYNN SEMMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 3RD ST STE 102
ENCINITAS CA
92024-3556
US

IV. Provider business mailing address

631 3RD ST STE 102
ENCINITAS CA
92024-3556
US

V. Phone/Fax

Practice location:
  • Phone: 760-583-6271
  • Fax:
Mailing address:
  • Phone: 760-583-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23587
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLCS23587
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerLCS LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: