Provider Demographics
NPI:1629090592
Name:NEWCOMER, JEANNE PATRICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:PATRICIA
Last Name:NEWCOMER
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 1:8180 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5122
Mailing Address - Country:US
Mailing Address - Phone:760-953-0429
Mailing Address - Fax:760-951-8986
Practice Address - Street 1:15447 ANACAPA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2481
Practice Address - Country:US
Practice Address - Phone:760-245-9446
Practice Address - Fax:760-951-8986
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS62001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6681536Medicaid
CA6681536Medicaid