Provider Demographics
NPI:1356681944
Name:JAMES SCRIBNER, JASON DANIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:JAMES SCRIBNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N MOUNTAIN AVE STE 219
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4165
Mailing Address - Country:US
Mailing Address - Phone:626-765-7277
Mailing Address - Fax:
Practice Address - Street 1:818 N MOUNTAIN AVE STE 219
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4165
Practice Address - Country:US
Practice Address - Phone:626-765-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71826104100000X
225400000X
CA1013831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner