Provider Demographics
NPI:1821135740
Name:MASTROIANNI-ALLEN, JODY A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:A
Last Name:MASTROIANNI-ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5541 E LA PASADA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4320
Mailing Address - Country:US
Mailing Address - Phone:213-709-4267
Mailing Address - Fax:
Practice Address - Street 1:5541 E LA PASADA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4320
Practice Address - Country:US
Practice Address - Phone:213-709-4267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW714631041C0700X
NY077945-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical