Doctor Name: | JENNA EYTON WOLFSON |
NPI Number: | 1265557136 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 60930 |
Business Practice Address: | 901 Ramona Ave # I Grover Beach, CA - 93433 |
Business Phone Number: | 8059048583 |
Business Fax Number: | |
Mailing Address: | 1655 Ramona Ave, GROVER BEACH |
State: | CA |
Postal Code: | 93433 |
Phone Number: | 8059048583 |
Fax Number: | |
NPI Enumeration Date: | 03/20/2007 |
NPI Last Update Date: | 04/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 60930 |
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 |