MEDICARE: JENNY RAZ LICENSED CLINICAL SOCIAL WORKER

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1578238366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNY RAZ LICENSED CLINICAL SOCIAL WORKER

Provider Business Mailing Address
First Line	:	PO BOX 502204
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92150-2204
Country	:	US
Telephone Number	:	619-981-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	13902 OLIVE MESA CT
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-3952
Country	:	US
Telephone Number	:	619-981-7101
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNY RAZ
Credential	:	LCSW
Telephone Number	:	619-981-7101

Provider Enumeration Date	:	08/12/2021
Last Update Date	:	08/12/2021

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