Provider Demographics
NPI:1417134446
Name:IRIZARRY, YVONNE JAZZ (LCSW)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:JAZZ
Last Name:IRIZARRY
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 1:2111 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-9001
Mailing Address - Country:US
Mailing Address - Phone:760-607-6503
Mailing Address - Fax:
Practice Address - Street 1:2111 S EL CAMINO REAL
Practice Address - Street 2:SUITE 300
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-9001
Practice Address - Country:US
Practice Address - Phone:760-607-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 7811041C0700X
FLSW94531041C0700X
CALCSW712911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical