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NPI Code Detail

MEDICARE: JENNIFER SHANE CALMELAT LCSW

MEDICARE: JENNIFER SHANE CALMELAT LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker00022988CA

General Provider Information

NPI Number : 1538290242
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER SHANE CALMELAT LCSW
Provider Business Mailing Address
First Line : 2594 INDUSTRY WAY
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-4015
Country : US
Telephone Number : 310-667-4070
Fax Number :
Provider Business Practice Location Address
First Line : 2594 INDUSTRY WAY
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-4015
Country : US
Telephone Number : 310-667-4070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 10/18/2018

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