Provider Demographics
NPI:1346363314
Name:COAST, JERI (LCSW)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:COAST
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 1:3150 EL CAMINO REAL STE C
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2110
Mailing Address - Country:US
Mailing Address - Phone:760-427-0095
Mailing Address - Fax:
Practice Address - Street 1:3150 EL CAMINO REAL STE C
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2110
Practice Address - Country:US
Practice Address - Phone:760-427-0095
Practice Address - Fax:760-630-9013
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS219091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical