Healthcare Provider Details

I. General information

NPI: 1508234907
Provider Name (Legal Business Name): JEREMIAH PAUL HEIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C230
LA JOLLA CA
92037-1712
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR STE C230
LA JOLLA CA
92037-1712
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: