Healthcare Provider Details

I. General information

NPI: 1629387410
Provider Name (Legal Business Name): JACQUELINE ESQUEF-NEDERLK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8342 QUARTZ AVE
WINNETKA CA
91306-1446
US

IV. Provider business mailing address

8342 QUARTZ AVE
WINNETKA CA
91306-1446
US

V. Phone/Fax

Practice location:
  • Phone: 818-269-9582
  • Fax: 818-886-8597
Mailing address:
  • Phone: 818-269-9582
  • Fax: 818-886-8597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: