MEDICARE: JONA LICENSED CLINICAL SOCIAL WORKER PC

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	106H00000X	Marriage & Family Therapist
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1932910825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONA LICENSED CLINICAL SOCIAL WORKER PC

Provider Business Mailing Address
First Line	:	1440 N HARBOR BLVD STE 937
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-519-4578
Fax Number	:	714-927-4221

Provider Business Practice Location Address
First Line	:	1440 N HARBOR BLVD STE 937
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-4127
Country	:	US
Telephone Number	:	714-519-4578
Fax Number	:	714-927-4221

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	EUNA PARK
Credential	:
Telephone Number	:	714-519-4578

Provider Enumeration Date	:	01/18/2025
Last Update Date	:	03/09/2026

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