Provider Demographics
NPI:1730655895
Name:SAUCEDA, JENAIAH LA'NEISE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENAIAH
Middle Name:LA'NEISE
Last Name:SAUCEDA
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 1:3130 BALFOUR RD # 135
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5515
Mailing Address - Country:US
Mailing Address - Phone:800-401-0565
Mailing Address - Fax:
Practice Address - Street 1:343 E MAIN ST STE 918
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202
Practice Address - Country:US
Practice Address - Phone:800-401-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA862091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical