Provider Demographics
NPI:1497439061
Name:HAYWOOD, JESSICA CARLON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:CARLON
Last Name:HAYWOOD
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:PO BOX 291341
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-9341
Mailing Address - Country:US
Mailing Address - Phone:352-205-0577
Mailing Address - Fax:
Practice Address - Street 1:2266 CAZADOR DRIVE
Practice Address - Street 2:UNIT 12
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-2047
Practice Address - Country:US
Practice Address - Phone:352-205-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1150281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical