Provider Demographics
NPI:1083130397
Name:VILLANUEVA, JEANETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:ZEPEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 FAIR OAKS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 N OLIVE AVE APT B
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-2273
Practice Address - Country:US
Practice Address - Phone:909-835-8867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA766361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical