Provider Demographics
NPI:1093693509
Name:BOLDEN, JENNIFER (ASW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23750 MOUNT VERNON PL
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9168
Mailing Address - Country:US
Mailing Address - Phone:760-450-7643
Mailing Address - Fax:
Practice Address - Street 1:41593 WINCHESTER RD STE 150
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4860
Practice Address - Country:US
Practice Address - Phone:951-775-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1302341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical