Provider Demographics
NPI:1598205544
Name:NAKAMURA, JENNIFER GREEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:GREEN
Last Name:NAKAMURA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2295 S VINEYARD AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7925
Mailing Address - Country:US
Mailing Address - Phone:909-724-3328
Mailing Address - Fax:
Practice Address - Street 1:2295 S VINEYARD AVE STE 230
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7925
Practice Address - Country:US
Practice Address - Phone:909-724-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA717761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical