Healthcare Provider Details

I. General information

NPI: 1790029700
Provider Name (Legal Business Name): JESSI NICOLE CORRAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY BLDG 651
MATHER CA
95655-4200
US

IV. Provider business mailing address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

V. Phone/Fax

Practice location:
  • Phone: 916-366-5428
  • Fax:
Mailing address:
  • Phone: 415-497-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: