Provider Demographics
NPI:1235994278
Name:RICE, JEREMY MICHAEL (ACSW)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:RICE
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BIRMINGHAM DR STE 240A
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1757
Mailing Address - Country:US
Mailing Address - Phone:858-208-0121
Mailing Address - Fax:858-381-9768
Practice Address - Street 1:120 BIRMINGHAM DR STE 240A
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1757
Practice Address - Country:US
Practice Address - Phone:858-208-0121
Practice Address - Fax:858-381-9768
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120182104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker