Healthcare Provider Details

I. General information

NPI: 1598135147
Provider Name (Legal Business Name): JENNA LYNN ZOTTARELLI MSW, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA LYNN WILLIAMS

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 10/16/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20342 FLANAGAN ROAD
TRABUCO CANYON CA
92679
US

IV. Provider business mailing address

15406 JACKSON ST
MIDWAY CITY CA
92655-1568
US

V. Phone/Fax

Practice location:
  • Phone: 818-582-8832
  • Fax: 818-582-8836
Mailing address:
  • Phone: 714-925-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW68893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: