Provider Demographics
NPI:1508982901
Name:PARODI, JACQUELINE NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:NICOLE
Last Name:PARODI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:NICOLE
Other - Last Name:VALIQUETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5497 SENECA PL
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2056
Mailing Address - Country:US
Mailing Address - Phone:805-205-5797
Mailing Address - Fax:
Practice Address - Street 1:5497 SENECA PL
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2056
Practice Address - Country:US
Practice Address - Phone:805-205-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS221721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 22172OtherCLINICAL LICENSE NUMBER