Provider Demographics
NPI:1891092367
Name:ZEPEDA, JORGE ANTONIO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ANTONIO
Last Name:ZEPEDA
Suffix:
Gender:M
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:PO BOX 900715
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-0715
Mailing Address - Country:US
Mailing Address - Phone:661-916-2390
Mailing Address - Fax:
Practice Address - Street 1:1061 W AVENUE M14 STE A
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1430
Practice Address - Country:US
Practice Address - Phone:661-916-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS162671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical