Healthcare Provider Details

I. General information

NPI: 1952963316
Provider Name (Legal Business Name): JENNIFER MICHELL EYO MORALES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E FOOTHILL BLVD
PASADENA CA
91107-3148
US

IV. Provider business mailing address

649 E ALBERTONI ST
CARSON CA
90746-1538
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number90485
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW113250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: