Provider Demographics
NPI:1225667686
Name:MIDDLETON, JERRI (LCSW)
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:
Last Name:MIDDLETON
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 1:5198 ARLINGTON AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2603
Mailing Address - Country:US
Mailing Address - Phone:951-223-8295
Mailing Address - Fax:
Practice Address - Street 1:2717 SPICEWOOD LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4319
Practice Address - Country:US
Practice Address - Phone:951-223-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical