Provider Demographics
NPI:1851877880
Name:MACIAS-CERVANTES, JESSICA (ACSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MACIAS-CERVANTES
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-758-7321
Mailing Address - Fax:661-758-7303
Practice Address - Street 1:928 F ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280
Practice Address - Country:US
Practice Address - Phone:661-758-7319
Practice Address - Fax:661-758-7303
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW117691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherMEDICAL
CA$$$$$$$$$Medicaid