Healthcare Provider Details

I. General information

NPI: 1841817350
Provider Name (Legal Business Name): JACQUELINE LAGUANA ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E WARDLOW RD
LONG BEACH CA
90807-4630
US

IV. Provider business mailing address

900 E WARDLOW RD
LONG BEACH CA
90807-4630
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-4525
  • Fax:
Mailing address:
  • Phone: 562-595-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: