Healthcare Provider Details

I. General information

NPI: 1366794851
Provider Name (Legal Business Name): JACLYN HOPE FERBER CALONNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN HOPE FERBER LCSW

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S FARRELL DR
PALM SPRINGS CA
92262-7905
US

IV. Provider business mailing address

20344 HIAWATHA ST
CHATSWORTH CA
91311-2565
US

V. Phone/Fax

Practice location:
  • Phone: 760-600-6042
  • Fax:
Mailing address:
  • Phone: 818-585-3475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76978
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW#33991
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW 33991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: