Provider Demographics
NPI:1114353455
Name:MOON, JEE-EUN JENNY (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:JEE-EUN
Middle Name:JENNY
Last Name:MOON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4510 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6914
Mailing Address - Country:US
Mailing Address - Phone:562-346-1143
Mailing Address - Fax:
Practice Address - Street 1:4510 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 600
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3279
Practice Address - Country:US
Practice Address - Phone:562-346-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA772661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health