Provider Demographics
NPI:1538484670
Name:MAUCERI, JENNIFER R (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MAUCERI
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 1:22048 SHERMAN WAY STE 115
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1893
Mailing Address - Country:US
Mailing Address - Phone:646-694-2434
Mailing Address - Fax:
Practice Address - Street 1:22048 SHERMAN WAY STE 115
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1893
Practice Address - Country:US
Practice Address - Phone:646-694-2434
Practice Address - Fax:818-891-8474
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0774491041C0700X
CA711791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100128996Medicaid
CA100128995Medicaid