Healthcare Provider Details

I. General information

NPI: 1396802047
Provider Name (Legal Business Name): JESSICA S CAUGHEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23388 MULHOLLAND DR M/S 260
WOODLAND HILLS CA
91364-2733
US

IV. Provider business mailing address

22110 DE LA OSA ST
WOODLAND HILLS CA
91364-3018
US

V. Phone/Fax

Practice location:
  • Phone: 818-876-4017
  • Fax:
Mailing address:
  • Phone: 818-914-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: