Provider Demographics
NPI:1790549087
Name:BERUBE, JEANA H (LCSW)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:H
Last Name:BERUBE
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 1:861 E 3625 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-4905
Mailing Address - Country:US
Mailing Address - Phone:801-710-2372
Mailing Address - Fax:
Practice Address - Street 1:433 N 1500 W
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-4746
Practice Address - Country:US
Practice Address - Phone:801-710-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT352385-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical