Provider Demographics
NPI:1295033124
Name:ANDERSON, JENNIFER PAIGE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PAIGE
Last Name:ANDERSON
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 1:8512 WHITWORTH DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2411
Mailing Address - Country:US
Mailing Address - Phone:310-360-8512
Mailing Address - Fax:310-360-8510
Practice Address - Street 1:8512 WHITWORTH DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2411
Practice Address - Country:US
Practice Address - Phone:310-360-8512
Practice Address - Fax:310-360-8510
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical