Provider Demographics
NPI:1699810408
Name:JANSEN, WOUTER NEIL JOHANNES (MSW)
Entity Type:Individual
Prefix:MR
First Name:WOUTER
Middle Name:NEIL JOHANNES
Last Name:JANSEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N LOMA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2828
Mailing Address - Country:US
Mailing Address - Phone:562-230-1833
Mailing Address - Fax:
Practice Address - Street 1:2177 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4505
Practice Address - Country:US
Practice Address - Phone:562-427-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14447104100000X
CA268441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical