Provider Demographics
NPI:1871021097
Name:VILLASENOR, JENNIFER MAO (ASW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAO
Last Name:VILLASENOR
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:ANNE
Other - Last Name:QUIGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:3719 COOMBS CT
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-8305
Mailing Address - Country:US
Mailing Address - Phone:707-298-7587
Mailing Address - Fax:
Practice Address - Street 1:3719 COOMBS CT
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-8305
Practice Address - Country:US
Practice Address - Phone:707-298-7587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA769471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical