Healthcare Provider Details

I. General information

NPI: 1104150697
Provider Name (Legal Business Name): JENNY CORTEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 10/23/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24436 RIDGEWOOD DRIVE
MURRIETA CA
92562-3851
US

IV. Provider business mailing address

769 W BLAINE ST SUITE B
RIVERSIDE CA
92507-3970
US

V. Phone/Fax

Practice location:
  • Phone: 323-382-2472
  • Fax:
Mailing address:
  • Phone: 951-358-4705
  • Fax: 951-358-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30615
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW 30615
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW66069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: