Healthcare Provider Details

I. General information

NPI: 1578238366
Provider Name (Legal Business Name): JENNY RAZ LICENSED CLINICAL SOCIAL WORKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13902 OLIVE MESA CT
POWAY CA
92064-3952
US

IV. Provider business mailing address

PO BOX 502204
SAN DIEGO CA
92150-2204
US

V. Phone/Fax

Practice location:
  • Phone: 619-981-7101
  • Fax:
Mailing address:
  • Phone: 619-981-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNY RAZ
Title or Position: PRESIDENT
Credential: LCSW
Phone: 619-981-7101