Provider Demographics
NPI:1043800600
Name:ADELLA JAEGER LCSW, PC
Entity Type:Organization
Organization Name:ADELLA JAEGER LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-392-4214
Mailing Address - Street 1:255 GRAND OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4809
Mailing Address - Country:US
Mailing Address - Phone:310-595-5984
Mailing Address - Fax:
Practice Address - Street 1:2520 SAINT ROSE PKWY STE 108
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7784
Practice Address - Country:US
Practice Address - Phone:844-933-8224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty