Provider Demographics
NPI:1679630529
Name:PEARL, JONI (LCSW)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:PEARL
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 1:29029 UPPER BEAR CREEK RD
Mailing Address - Street 2:#302
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7738
Mailing Address - Country:US
Mailing Address - Phone:303-670-6501
Mailing Address - Fax:
Practice Address - Street 1:29029 UPPER BEAR CREEK RD
Practice Address - Street 2:#302
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7738
Practice Address - Country:US
Practice Address - Phone:303-670-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9890571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical