Provider Demographics
NPI:1609201607
Name:GWINN, JAVONNE N (ASW)
Entity Type:Individual
Prefix:MRS
First Name:JAVONNE
Middle Name:N
Last Name:GWINN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 GUERRERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1015
Mailing Address - Country:US
Mailing Address - Phone:415-503-1735
Mailing Address - Fax:415-520-0838
Practice Address - Street 1:450 GUERRERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1015
Practice Address - Country:US
Practice Address - Phone:415-503-1735
Practice Address - Fax:415-520-0838
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW36974104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker