Provider Demographics
NPI:1376653386
Name:JORENTO, DAINE QIAO (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAINE
Middle Name:QIAO
Last Name:JORENTO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5316
Mailing Address - Country:US
Mailing Address - Phone:651-815-5145
Mailing Address - Fax:
Practice Address - Street 1:442 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-5316
Practice Address - Country:US
Practice Address - Phone:651-815-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical