Healthcare Provider Details

I. General information

NPI: 1407437411
Provider Name (Legal Business Name): JENNA MICHELLE SCOTTO ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 ATLANTIC AVE
LONG BEACH CA
90805-6510
US

IV. Provider business mailing address

1240 E 17TH ST APT 5
LONG BEACH CA
90813-2254
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-4111
  • Fax:
Mailing address:
  • Phone: 562-206-5083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21658
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: