Healthcare Provider Details

I. General information

NPI: 1124634167
Provider Name (Legal Business Name): JACKLYN PRICELLA SAUCEDO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BIRCH ST STE 3000
NEWPORT BEACH CA
92660-2140
US

IV. Provider business mailing address

1407 MONTEREY RD # C
SOUTH PASADENA CA
91030-3897
US

V. Phone/Fax

Practice location:
  • Phone: 877-421-1711
  • Fax: 949-576-3913
Mailing address:
  • Phone: 626-437-9789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number132581
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: