Doctor Name: | MS. JEANETTE CHURCHILL-MATILLO |
NPI Number: | 1194923003 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | LCS8967 |
Business Practice Address: | 24726 Meridian Dr Dana Point, CA - 926291819 |
Business Phone Number: | 9492485599 |
Business Fax Number: | 9492485560 |
Mailing Address: | 24726 Meridian Dr, DANA POINT |
State: | CA |
Postal Code: | 926291819 |
Phone Number: | 9492485599 |
Fax Number: | 9492485560 |
NPI Enumeration Date: | 07/03/2007 |
NPI Last Update Date: | 01/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LCS8967 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |