Healthcare Provider Details

I. General information

NPI: 1932910825
Provider Name (Legal Business Name): JONA LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 N HARBOR BLVD STE 937
FULLERTON CA
92835-4127
US

IV. Provider business mailing address

1440 N HARBOR BLVD STE 937
FULLERTON CA
92835-4127
US

V. Phone/Fax

Practice location:
  • Phone: 714-519-4578
  • Fax: 714-927-4221
Mailing address:
  • Phone: 714-519-4578
  • Fax: 714-927-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: EUNA PARK
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential:
Phone: 714-519-4578