Provider Demographics
NPI:1033619754
Name:MARNOCHA, JANE A (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:MARNOCHA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 CAMINITO DEL CERVATO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6853
Mailing Address - Country:US
Mailing Address - Phone:619-890-9100
Mailing Address - Fax:
Practice Address - Street 1:6348 CAMINITO DEL CERVATO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6853
Practice Address - Country:US
Practice Address - Phone:619-890-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA806921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical