MEDICARE: MS. TUCKER JESS MATHENY MSW, ACSW

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	104100000X	Social Worker	120960	CA

General Provider Information

NPI Number	:	1790539575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TUCKER JESS MATHENY MSW, ACSW

Provider Business Mailing Address
First Line	:	3989 W STETSON AVE
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92545-9695
Country	:	US
Telephone Number	:	858-289-1469
Fax Number	:

Provider Business Practice Location Address
First Line	:	3989 W STETSON AVE
Second Line	:
City	:	HEMET
State	:	CA
Zip	:	92545-9695
Country	:	US
Telephone Number	:	858-289-1469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	04/16/2024

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