Provider Demographics
NPI:1508998584
Name:FINK, JEREMY B (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:B
Last Name:FINK
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 1:28310 ROADSIDE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4950
Mailing Address - Country:US
Mailing Address - Phone:818-575-6065
Mailing Address - Fax:
Practice Address - Street 1:28310 ROADSIDE DR STE 140
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4950
Practice Address - Country:US
Practice Address - Phone:818-575-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical