Healthcare Provider Details

I. General information

NPI: 1831487545
Provider Name (Legal Business Name): JACQUELINE YANEZ MSW, ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE MIRAMONTES MSW, ASW

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 W MAIN ST
MERCED CA
95340-4438
US

IV. Provider business mailing address

3558 MIRAMAR CT
MERCED CA
95348-9512
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-1060
  • Fax: 209-725-1064
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: