Provider Demographics
NPI:1578238366
Name:JENNY RAZ LICENSED CLINICAL SOCIAL WORKER
Entity Type:Organization
Organization Name:JENNY RAZ LICENSED CLINICAL SOCIAL WORKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-981-7101
Mailing Address - Street 1:PO BOX 502204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-2204
Mailing Address - Country:US
Mailing Address - Phone:619-981-7101
Mailing Address - Fax:
Practice Address - Street 1:13902 OLIVE MESA CT
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-3952
Practice Address - Country:US
Practice Address - Phone:619-981-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty