Provider Demographics
NPI:1598135147
Name:ZOTTARELLI, JENNA LYNN (MSW, MA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:ZOTTARELLI
Suffix:
Gender:F
Credentials:MSW, MA
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LYNN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15406 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1568
Mailing Address - Country:US
Mailing Address - Phone:714-925-8629
Mailing Address - Fax:
Practice Address - Street 1:20342 FLANAGAN ROAD
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679
Practice Address - Country:US
Practice Address - Phone:818-582-8832
Practice Address - Fax:818-582-8836
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW68893101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health