Provider Demographics
NPI:1053858183
Name:HOSHIDE, JENNY MANOG (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MANOG
Last Name:HOSHIDE
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 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:SOCIAL WORK SERVICE, 1538
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-3211
Mailing Address - Country:US
Mailing Address - Phone:619-497-8989
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:SOCIAL WORK SERVICE, 1538
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-3211
Practice Address - Country:US
Practice Address - Phone:619-497-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA718081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical