Provider Demographics
NPI:1710074190
Name:CUMMINGS, JUANITA LUISA (MASTER SOCIAL WORKER)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:LUISA
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:MASTER SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6117 OAK FENCE LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1795
Mailing Address - Country:US
Mailing Address - Phone:661-802-7483
Mailing Address - Fax:
Practice Address - Street 1:520 W PALMDALE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4229
Practice Address - Country:US
Practice Address - Phone:661-575-8395
Practice Address - Fax:661-272-2784
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW31460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACO437820OtherDRIVERS LICENSE