Healthcare Provider Details

I. General information

NPI: 1851823710
Provider Name (Legal Business Name): HEATHER PARENTI, LICENSED CLINICAL SOCIAL WORKE, I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27710 JEFFERSON AVE 205
TEMECULA CA
92590-4604
US

IV. Provider business mailing address

27710 JEFFERSON AVE 205
TEMECULA CA
92590-4604
US

V. Phone/Fax

Practice location:
  • Phone: 951-805-4025
  • Fax: 951-380-8487
Mailing address:
  • Phone: 951-805-4025
  • Fax: 951-380-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19194
License Number StateCA

VIII. Authorized Official

Name: MS. HEATHER LOUISE PARENTI
Title or Position: PRESIDENT
Credential: L.C.S.W.
Phone: 951-805-4025