Healthcare Provider Details

I. General information

NPI: 1952268443
Provider Name (Legal Business Name): JENINE LYNN AGUON CABRERA DAMIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S MARINE CORPS DR STE 102
TAMUNING GU
96913-3572
US

IV. Provider business mailing address

1270 N. MARINE CORPS DR. PMB 1053 SUITE 101
TAMUNING GU
96913
US

V. Phone/Fax

Practice location:
  • Phone: 671-989-1962
  • Fax: 671-989-5579
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-E-048
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: